Provider Demographics
NPI:1780578765
Name:SISON, JACLYN NICOLE (APRN)
Entity type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:NICOLE
Last Name:SISON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:JACLYN
Other - Middle Name:NICOLE
Other - Last Name:FERRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2227 79TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6803
Mailing Address - Country:US
Mailing Address - Phone:206-422-6857
Mailing Address - Fax:
Practice Address - Street 1:2227 79TH AVE SE
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-6803
Practice Address - Country:US
Practice Address - Phone:206-422-6857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP70009126363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily