Provider Demographics
NPI:1972120129
Name:PORZUCEK, JACQUELYN SCHNACKEL (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:SCHNACKEL
Last Name:PORZUCEK
Suffix:
Gender:
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:FAIN
Other - Last Name:SCHNACKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-CNP
Mailing Address - Street 1:111 COLCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1473
Mailing Address - Country:US
Mailing Address - Phone:802-847-2370
Mailing Address - Fax:
Practice Address - Street 1:111 COLCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-1473
Practice Address - Country:US
Practice Address - Phone:802-847-2370
Practice Address - Fax:802-847-8590
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT026.0152967163WN0002X
VT101.0136923363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care