Provider Demographics
NPI:1710239397
Name:BAJEK, JACLYN N (FNP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:N
Last Name:BAJEK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13640 STEELECROFT PKWY
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-7796
Mailing Address - Country:US
Mailing Address - Phone:704-674-3511
Mailing Address - Fax:
Practice Address - Street 1:9034 WING POINTE DR
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-6736
Practice Address - Country:US
Practice Address - Phone:704-674-3511
Practice Address - Fax:704-479-6514
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005842363LA2100X
NC213946363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care