Timothy Edward Jackinsky, NURSE PRACTITIONER

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

CANP16793 Issued in CA

Practice address

1441 Ala Moana Blvd Ste 1600
Honolulu, HI 96814

Phone

(808) 432-7600

NPI assigned

Jan 25, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• County of Mendocino

  • Community/Behavioral Health Agency
  • Fort Bragg, CA
  • NPI 1194853713
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1528114519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 ALA MOANA BLVD",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "96814",
            "telephone_number": "808-432-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 ALA MOANA BLVD STE 1600",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "96814",
            "telephone_number": "808-432-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "790 S Franklin",
            "address_2": "B",
            "address_purpose": "LOCATION",
            "city": "Ft Bragg",
            "state": "CA",
            "postal_code": "95437",
            "country_code": "US",
            "telephone_number": "707-964-4747",
            "fax_number": "707-962-2698",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JACKINSKY",
        "first_name": "TIMOTHY",
        "middle_name": "EDWARD",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-25",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "CA452024",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "CANP16793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/interconnect-prodhim/wcf/epic.community.hie/xcpdrespondinggateways",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1441 Ala Moana Blvd Ste 1600",
            "city": "Honolulu",
            "state": "HI",
            "country_code": "US",
            "postal_code": "96814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cynthia Sue J'Anthony, PH.D.
• Kristin Jablonski, RD
• Amelia Reyes Jacang, M.D.
• Mary Jane Jacinto, MSW, LCSW
• Jack Jie Zhou MD Inc.
• David Jules Jackowe, M.D.
• Angela Jackowski, RN
• Harry J. Jackson, DDS
• Kathryn Jackson
• Micheal Craig Jackson

• Nurse Practitioner in Honolulu, HI
• Providers in Honolulu, HI by specialty
• Nurse Practitioner in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.