Provider Demographics
NPI:1083037725
Name:WITTENAUER, JACOB (PA-C ATC)
Entity Type:Individual
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First Name:JACOB
Middle Name:
Last Name:WITTENAUER
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Gender:M
Credentials:PA-C ATC
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Other - Credentials:
Mailing Address - Street 1:PO BOX 788250
Mailing Address - Street 2:NAVAL HOSPITAL TWENTY NINE PALMS
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92278-8250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BROOKE ARMY MEDICAL CENTER
Practice Address - Street 2:3551 FORT SAM HOUSTON
Practice Address - City:JBSA FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2023-08-16
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant