Provider Demographics
NPI:1588841175
Name:CABALLERO-ASTA, JAKELINNE E (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAKELINNE
Middle Name:E
Last Name:CABALLERO-ASTA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:JAKELINNE
Other - Middle Name:E
Other - Last Name:CABALLERO-ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 8932
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8932
Mailing Address - Country:US
Mailing Address - Phone:203-739-7038
Mailing Address - Fax:
Practice Address - Street 1:111 OSBORNE STREET
Practice Address - Street 2:
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810
Practice Address - Country:US
Practice Address - Phone:203-739-7038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012141-1363AM0700X
CT002767363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT061137OtherWCMG TAX ID #