Provider Demographics
NPI:1588351217
Name:SNOW, JACKLYN (FNP)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:
Last Name:SNOW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ATTUCKS LN UNIT 1E
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1809
Mailing Address - Country:US
Mailing Address - Phone:508-771-6108
Mailing Address - Fax:
Practice Address - Street 1:700 ATTUCKS LN UNIT 1E
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1809
Practice Address - Country:US
Practice Address - Phone:508-771-6108
Practice Address - Fax:800-465-3203
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2325155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily