Provider Demographics
NPI:1154505303
Name:GIL, JACQUELINE GRACE (RPA-C)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:GRACE
Last Name:GIL
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 MAIN ST BOX 1128
Mailing Address - Street 2:
Mailing Address - City:CENTER MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11934
Mailing Address - Country:US
Mailing Address - Phone:631-878-1043
Mailing Address - Fax:
Practice Address - Street 1:445 MAIN ST # 1128
Practice Address - Street 2:
Practice Address - City:CENTER MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11934-3512
Practice Address - Country:US
Practice Address - Phone:631-878-1043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23 012327363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical