Provider Demographics
NPI:1598913410
Name:TOUART, JACIE CHRISTINE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:JACIE
Middle Name:CHRISTINE
Last Name:TOUART
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACIE
Other - Middle Name:CHRISTINE
Other - Last Name:FREIMUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4420 DUCKHORN DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-2590
Mailing Address - Country:US
Mailing Address - Phone:916-419-9900
Mailing Address - Fax:916-419-9699
Practice Address - Street 1:4420 DUCKHORN DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2590
Practice Address - Country:US
Practice Address - Phone:916-419-9900
Practice Address - Fax:916-419-9699
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19848363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF180ZMedicare PIN
CABF180YMedicare PIN