Provider Demographics
NPI:1639472376
Name:JAKOBCIC, ELIZABETH F (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:F
Last Name:JAKOBCIC
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43494 WOODWARD AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48302-5052
Mailing Address - Country:US
Mailing Address - Phone:248-332-4629
Mailing Address - Fax:248-322-5490
Practice Address - Street 1:43494 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-5052
Practice Address - Country:US
Practice Address - Phone:248-332-4629
Practice Address - Fax:248-322-5490
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-20
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601005893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant