Provider Demographics
NPI:1104461433
Name:PALMIOTTI, JACQUELINE EMILIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:EMILIA
Last Name:PALMIOTTI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:EMILIA
Other - Last Name:LINDINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3144 OLD FRANKLIN RD APT 10201
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-1699
Mailing Address - Country:US
Mailing Address - Phone:845-699-5604
Mailing Address - Fax:
Practice Address - Street 1:376 E WARM SPRINGS RD STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4241
Practice Address - Country:US
Practice Address - Phone:702-848-4443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2186363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant