Provider Demographics
NPI:1083675326
Name:PACETTI, FRANK OLIVER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FRANK
Middle Name:OLIVER
Last Name:PACETTI
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:904-244-3199
Mailing Address - Fax:904-244-3425
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP SJ COMMUNITY HEALTH CENTER
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-5121
Practice Address - Fax:904-244-5965
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA2342363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100002827AMedicaid
FL2905060-00Medicaid
GA100002827AMedicaid
FLE0625ZMedicare PIN
FLS54477Medicare UPIN
FL2905060-00Medicaid