Provider Demographics
NPI:1689967747
Name:VINCENT, ALAINA JACOBI (PA-C)
Entity Type:Individual
Prefix:
First Name:ALAINA
Middle Name:JACOBI
Last Name:VINCENT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ALAINA
Other - Middle Name:
Other - Last Name:JACOBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 E STATE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3434
Mailing Address - Country:US
Mailing Address - Phone:610-565-2776
Mailing Address - Fax:610-565-4247
Practice Address - Street 1:200 E STATE ST STE 205
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-565-2776
Practice Address - Fax:610-565-4247
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053281363A00000X
DEC5-0000923363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant