Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacqueline S Phillip

Individual provider Nurse Practitioner · NPI 1821879867

Jacqueline S Phillip is a Nurse Practitioner in Staten Island, New York. Qualified in 2021, 5 years ago. Practices with Shakespeare Operating LLC, a 137-clinician group, accepts Medicare assignment and offers telehealth. Licensed in New York.

Years since qualifying
5
Licensed in
NY
In the registry since
2023
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Practice location Address checks out

1915 Forest Ave
Staten Island, NY 10303-2127
Phone: (718) 981-3136
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence F405202-1 (NY)

Record details

NPI number1821879867
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 6, 2023
Last updated in NPPESOctober 6, 2023
Certification dateOctober 6, 2023

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Shakespeare Operating Llc — 137 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

Other providers in Staten Island