Provider Demographics
NPI:1548394711
Name:DE WITT, JOCELYN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:DE WITT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 OWENS ST
Mailing Address - Street 2:BOX 3004
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2334
Mailing Address - Country:US
Mailing Address - Phone:415-353-2808
Mailing Address - Fax:414-885-3862
Practice Address - Street 1:1500 OWENS ST
Practice Address - Street 2:BOX 3004
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2334
Practice Address - Country:US
Practice Address - Phone:415-353-2808
Practice Address - Fax:414-885-3862
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21607363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1518856OtherDEA