Provider Demographics
NPI:1295376473
Name:PACILIO, JAMIE AUSTIN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:AUSTIN
Last Name:PACILIO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 BROAD ST STE 207
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-2009
Mailing Address - Country:US
Mailing Address - Phone:732-576-3727
Mailing Address - Fax:630-487-2411
Practice Address - Street 1:211 BROAD ST STE 207
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-2009
Practice Address - Country:US
Practice Address - Phone:732-576-3727
Practice Address - Fax:630-487-2411
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MP00584400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program