Provider Demographics
NPI:1407104227
Name:JUNGLAS, JACQUELINE M (CRNA)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:JUNGLAS
Suffix:
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:M
Other - Last Name:SITKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:ONE GI CREDENTIALING DEPARTMENT
Mailing Address - Street 2:PO BOX 381468
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1468
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36000 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4625
Practice Address - Country:US
Practice Address - Phone:440-350-0832
Practice Address - Fax:440-579-0191
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13947-NA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered