| Doctor Name: | JESSICA LYNN TKACH |
| NPI Number: | 1003142118 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 4704245661 |
| Business Practice Address: | 2025 Ford Ave Wyandotte, MI - 481922312 |
| Business Phone Number: | 7342813080 |
| Business Fax Number: | 7342818815 |
| Mailing Address: | 2025 Ford Ave, WYANDOTTE |
| State: | MI |
| Postal Code: | 481922312 |
| Phone Number: | 7342813080 |
| Fax Number: | 7342818815 |
| NPI Enumeration Date: | 10/23/2009 |
| NPI Last Update Date: | 10/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LC0200X |
| License Number: | 4704245661 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Critical Care Medicine |
| Taxonomy Definition: | |