Jacqueline Annette Sroka, NP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

204903 Issued in NC

Practice address

1000 Blythe Blvd
Charlotte, NC 28203-5812

Phone

(704) 446-1242

Fax

(704) 446-1241

NPI assigned

Nov 30, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Jacqueline Annette Fugiel Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Suburban Endocrinology & Diabetes

  dba Suburban Endocrinology & Diabetes Center

  • Endocrinology, Diabetes & Metabolism Physician
  • Arlington Heights, IL
  • NPI 1780879866
  Medicare reassignment

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

{
    "created_epoch": "1259539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336348800000",
    "number": "1689902777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601372",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601372",
            "telephone_number": "704-446-1242",
            "fax_number": "704-446-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-446-1242",
            "fax_number": "704-446-1241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SROKA",
        "first_name": "JACQUELINE",
        "middle_name": "ANNETTE",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-11-30",
        "last_updated": "2012-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "204903",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP1574",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7005234",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELINE",
            "last_name": "FUGIEL",
            "middle_name": "ANNETTE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kimberly S Squires, FNP-C; PMHNP-BC
• Malcolm Hart Squires III, MD
• Rebekah Squires, PHD
• Harley Squittieri
• Keri Anne Squittieri, PA-C
• Oliver Casper Sroka, MD
• SSC Charlotte Operating Company LLC (Brian Center Health and Rehabilitation - Charlotte)
• SSC Charlotte Shamrock Operating Company LLC (Brian Center Nursing Care - Shamrock)
• SSMH Services LLC
• Rick E St George, PT, OCS

• Family Nurse Practitioner in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.