Provider Demographics
NPI:1225718562
Name:TKACSIK, JENNA MARIE (PAC)
Entity type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:TKACSIK
Suffix:
Gender:
Credentials:PAC
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:STRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 160
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30115-8029
Mailing Address - Country:US
Mailing Address - Phone:770-721-9050
Mailing Address - Fax:770-721-9051
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 160
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8029
Practice Address - Country:US
Practice Address - Phone:770-721-9050
Practice Address - Fax:770-721-9051
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12938363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant