Active NPI
Jacqueline Spathakis
- Registered Nurse
- Camp Hill, PA
National Provider Identifier
1053037986
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- E54698
- Practice address
- 30 Hunter LN
Camp Hill, PA 17011-2400 - Phone
- (800) 748-3243
- NPI assigned
- Oct 12, 2022
- Last updated
- Oct 12, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | E54698 | CT | Primary |
Addresses
Primary practice location
30 Hunter LN
Camp Hill, PA 17011-2400
Mailing address
4 Bittersweet Way
Stonington, CT 06378-2329
Phone (860) 303-2645
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E54698 | CT | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1665532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1665532800000",
"number": "1053037986",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4 BITTERSWEET WAY",
"city": "STONINGTON",
"state": "CT",
"postal_code": "063782329",
"telephone_number": "860-303-2645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 HUNTER LN",
"city": "CAMP HILL",
"state": "PA",
"postal_code": "170112400",
"telephone_number": "800-748-3243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPATHAKIS",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-12",
"last_updated": "2022-10-12",
"certification_date": "2022-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CT",
"license": "E54698",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Camp Hill, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.