Provider Demographics
NPI:1003514894
Name:FILIPPONE, JACOB EDWARD (PA)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:EDWARD
Last Name:FILIPPONE
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:110 GUTHRIE RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-1691
Mailing Address - Country:US
Mailing Address - Phone:865-201-4483
Mailing Address - Fax:
Practice Address - Street 1:7565 DANNAHER DR
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:TN
Practice Address - Zip Code:37849-4029
Practice Address - Country:US
Practice Address - Phone:865-859-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-21
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant