Provider Demographics
NPI:1578621157
Name:HOLLCRAFT, JACQUELINE FRANCIS (PAC)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:FRANCIS
Last Name:HOLLCRAFT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:FRANCIS
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5800 LANDERBROOK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6510
Mailing Address - Country:US
Mailing Address - Phone:440-443-0423
Mailing Address - Fax:440-443-0414
Practice Address - Street 1:4124 MUNSON ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-4804
Practice Address - Country:US
Practice Address - Phone:440-443-0330
Practice Address - Fax:234-410-7549
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16968363A00000X
OH50.006278RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant