Individual
STEPHANIE JACKOB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Contact information
Practice address
488 FREEDOM PLAINS RD, POUGHKEEPSIE, NY 12603-2689
(845) 452-5151
Mailing address
15 LARCHMONT DR, HOPEWELL JUNCTION, NY 12533-5226
(914) 474-0248
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
311229
NY
Other
Enumeration date
03/31/2023
Last updated
04/11/2023
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