Lisa Ellen Jacavone, RN/NP

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

RN2274406 Issued in MA

Practice address

830 Chalkstone Ave
Providence, RI 02908-4734

Phone

(401) 273-7100

Fax

(401) 459-4797

NPI assigned

Oct 4, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in RI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

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

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674518400000",
    "number": "1801084751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084734",
            "telephone_number": "401-273-7100",
            "fax_number": "401-459-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 CHALKSTONE AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029084734",
            "telephone_number": "401-273-7100",
            "fax_number": "401-459-4797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACAVONE",
        "first_name": "LISA",
        "middle_name": "ELLEN",
        "credential": "RN/NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-10-04",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "RI",
            "license": "RN36765",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "RI",
            "license": "NPP37867",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "RI",
            "license": "APRN01777",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MA",
            "license": "RN2274406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANCED PRACTICE REGISTERED NURSE LICENSE",
            "identifier": "APRN01777",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFIED NURSE PRACTITIONER",
            "identifier": "CNP2274406",
            "state": "MA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Lisa.Jacavone@va.gov",
            "affiliation": "N",
            "endpointDescription": "Government email address secured",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "830 Chalkstone Ave",
            "city": "Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029084734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• J&J Medical Transportation LLC
• J3 Advisory LLC
• Grace Nazaree Jablonski, APRN
• Brianna Maia Jabon, DO
• Moune Jabre Raughley, MD
• Carl-Christian Andrew Jackson, MD
• Carnell Jackie Jackson, MSW
• Charlotte Jackson, MD
• Chris Jackson, LMHC
• Cynthia Jackson, PH.D.

• Acute Care Nurse Practitioner in Providence, RI
• Providers in Providence, RI by specialty
• Acute Care Nurse Practitioner in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; 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.