Provider Demographics
NPI:1073339065
Name:ENCALADA, JAZMINE KATHERINE (PA)
Entity type:Individual
Prefix:
First Name:JAZMINE
Middle Name:KATHERINE
Last Name:ENCALADA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E STATE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5547
Mailing Address - Country:US
Mailing Address - Phone:347-461-6936
Mailing Address - Fax:
Practice Address - Street 1:215 E STATE ST STE 5
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5547
Practice Address - Country:US
Practice Address - Phone:607-274-7007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant