Provider Demographics
NPI:1083885206
Name:SHAFFER, JANA NICOLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:NICOLE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JANA
Other - Middle Name:NICOLE
Other - Last Name:POLSLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 E MAIN ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5369
Mailing Address - Country:US
Mailing Address - Phone:614-224-4566
Mailing Address - Fax:
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:SUITE 310
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5369
Practice Address - Country:US
Practice Address - Phone:614-224-4566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-15
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-003188363A00000X
OH50.003713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00848933Medicare PIN
IL964290008Medicare PIN