Provider Demographics
NPI:1487808499
Name:SMITH, JACQUELINE S (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:S
Last Name:SMITH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:S
Other - Last Name:FILIPKOWSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1101 PENINSULA DR STE 202
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4169
Mailing Address - Country:US
Mailing Address - Phone:814-833-5381
Mailing Address - Fax:814-833-5387
Practice Address - Street 1:1101 PENINSULA DR STE 202
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4169
Practice Address - Country:US
Practice Address - Phone:814-833-5381
Practice Address - Fax:814-833-5387
Is Sole Proprietor?:No
Enumeration Date:2008-11-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053610363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant