Provider Demographics
NPI:1902625585
Name:ACKLAND, JEANETTE TOURTELOT (APRN)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:TOURTELOT
Last Name:ACKLAND
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JEANETTE
Other - Middle Name:
Other - Last Name:TOURTELOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 713260
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1260
Mailing Address - Country:US
Mailing Address - Phone:920-063-0469
Mailing Address - Fax:
Practice Address - Street 1:2359 HASSELL RD
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-2102
Practice Address - Country:US
Practice Address - Phone:847-843-7030
Practice Address - Fax:847-843-2430
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209030755363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner