Provider Demographics
NPI:1215084058
Name:PLACENCIA, JACKELINE (RPA-C)
Entity type:Individual
Prefix:MRS
First Name:JACKELINE
Middle Name:
Last Name:PLACENCIA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 NW 118TH LN
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5048
Mailing Address - Country:US
Mailing Address - Phone:954-826-7215
Mailing Address - Fax:754-484-7155
Practice Address - Street 1:319 HOOPER ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-6450
Practice Address - Country:US
Practice Address - Phone:718-486-7116
Practice Address - Fax:754-484-7155
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9104564363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant