Provider Demographics
NPI:1437975182
Name:JASKOT, PHILLIP ALAN (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:ALAN
Last Name:JASKOT
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8099 BRIGHTSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PLAIN CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43064-3679
Mailing Address - Country:US
Mailing Address - Phone:614-460-0954
Mailing Address - Fax:
Practice Address - Street 1:4770 INDIANOLA AVE STE 111
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1862
Practice Address - Country:US
Practice Address - Phone:614-427-3205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0038010363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health