Provider Demographics
NPI:1558880906
Name:STEWART, JACQUELYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:JACQUELYNN
Middle Name:
Last Name:STEWART
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 1:1001 E 17TH ST APT 110
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-6768
Mailing Address - Country:US
Mailing Address - Phone:405-885-7164
Mailing Address - Fax:
Practice Address - Street 1:890 W ELLIOT RD STE 102
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5127
Practice Address - Country:US
Practice Address - Phone:480-500-2285
Practice Address - Fax:919-882-8575
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant