Provider Demographics
NPI:1194470021
Name:PALMER, JACQUELINE NICOLE (MCMSC, PA-C)
Entity Type:Individual
Prefix:MISS
First Name:JACQUELINE
Middle Name:NICOLE
Last Name:PALMER
Suffix:
Gender:F
Credentials:MCMSC, PA-C
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Mailing Address - Street 1:40 N SHORE BLVD APT 217
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-2389
Mailing Address - Country:US
Mailing Address - Phone:440-539-5993
Mailing Address - Fax:
Practice Address - Street 1:1200 DRIVING PARK AVE STE 4
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1090
Practice Address - Country:US
Practice Address - Phone:315-359-2696
Practice Address - Fax:315-359-2699
Is Sole Proprietor?:No
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant