Provider Demographics
NPI:1063607067
Name:CORMIER, JAIME LEE (PA)
Entity type:Individual
Prefix:MRS
First Name:JAIME
Middle Name:LEE
Last Name:CORMIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LEE
Other - Last Name:JARONKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:8333 NAAB RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5924
Mailing Address - Country:US
Mailing Address - Phone:317-338-6666
Mailing Address - Fax:317-338-6066
Practice Address - Street 1:8333 NAAB RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5924
Practice Address - Country:US
Practice Address - Phone:317-338-6666
Practice Address - Fax:317-338-6066
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL001000877363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0708PAMedicaid