JACLYN ANN FUSCO NPI 1063113355

NPI Information

  • NPI: 1063113355
  • Provider Name: JACLYN ANN FUSCO
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 100 NAVARRE PL STE 5550
    SOUTH BEND, IN
    ZIP 46601
  • Phone: (574) 647-2550

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NPI Details

Jaclyn Ann Fusco is a pediatrics nurse practitioner in South Bend, IN. Jaclyn Ann Fusco NPI is 1063113355. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

100 NAVARRE PL STE 5550
SOUTH BEND, IN
ZIP 46601-169
Phone: (574) 647-2550

The NPI 1063113355 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 3/14/2023 and was last updated on 4/2/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163W00000XRegistered Nurse28265298AINDIANANo
2363LP0200XNurse PractitionerPediatrics202325197INDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1300078118MEDICAIDINDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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