Provider Demographics
NPI:1437591781
Name:DIGRAZIANO, JAMIE LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:DIGRAZIANO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JAMIE
Other - Middle Name:LYNN
Other - Last Name:PONTAROLLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:325 PRINCETON AVE
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-1617
Mailing Address - Country:US
Mailing Address - Phone:609-924-8131
Mailing Address - Fax:609-924-8532
Practice Address - Street 1:325 PRINCETON AVE
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-1617
Practice Address - Country:US
Practice Address - Phone:609-924-8131
Practice Address - Fax:609-924-8532
Is Sole Proprietor?:No
Enumeration Date:2013-07-26
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00314100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant