Jacob Domoracki, CRNP | |
232 W 25th St, Erie, PA 16544-0001 | |
(814) 452-5000 | |
Not Available |
Full Name | Jacob Domoracki |
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Gender | Male |
Speciality | Nurse Practitioner - Acute Care |
Location | 232 W 25th St, Erie, Pennsylvania |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1245919448 | NPI | - | NPPES |
RN670780 | Other | PA | REGISTERED NURSE LICENSE |
SP028313 | Other | PA | CERTIFIED REGISTERED NURSE PRACTITIONER - ADULT-GERONTOLOGY ACUTE CARE |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
163WC0200X | Registered Nurse - Critical Care Medicine | RN670780 (Pennsylvania) | Secondary |
363LA2100X | Nurse Practitioner - Acute Care | SP028313 (Pennsylvania) | Primary |
Entity Name | Saint Vincent Consultants In Cardiovascular Diseases |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1902114911 PECOS PAC ID: 7214124221 Enrollment ID: O20101202001178 |
Mailing Address | Practice Location Address |
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Jacob Domoracki, CRNP 870 Broad St, Conneaut, OH 44030-1710 Ph: (216) 882-7044 | Jacob Domoracki, CRNP 232 W 25th St, Erie, PA 16544-0001 Ph: (814) 452-5000 |
Tatyana Kryachkov, CRNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 3250 W Lake Rd., Suite 2, Erie, PA 16505 Phone: 814-790-4567 Fax: 814-295-4074 | |
Jennifer Flo Norris, CRNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 4120 Westminster Blvd, Erie, PA 16506 Phone: 814-440-2278 | |
Devon Singh, Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 120 E 2nd St Fl 2, 2nd Floor, Erie, PA 16507 Phone: 814-456-8980 | |
Lynn Gates, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 201 State St, Erie, PA 16550 Phone: 814-877-4922 | |
Nicole Friedl, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 201 State St, Erie, PA 16550 Phone: 814-877-4922 | |
Linda Kathleen Mentz, CRNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4500 Pine Ave, Erie, PA 16504 Phone: 814-877-5800 Fax: 814-877-5809 | |
Mr. Kenneth Charles Agnew Jr., CRNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 5037 Crystal Dr, Erie, PA 16505 Phone: 814-218-1850 |