Individual
JACOB DOMORACKI
Active
Individual
JACOB DOMORACKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
RN670780
PA
363LA2100X
Acute Care Nurse Practitioner
Primary
SP028313
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN670780
REGISTERED NURSE LICENSE
PA
01
—
SP028313
CERTIFIED REGISTERED NURSE PRACTITIONER - ADULT-GERONTOLOGY ACUTE CARE
PA
Enumeration date
07/14/2023
Last updated
11/07/2023
Update your record
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