Provider Demographics
NPI:1790788974
Name:ENGLE, JOCELYN J (PA)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:J
Last Name:ENGLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:J
Other - Last Name:EGGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:30 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-2658
Mailing Address - Country:US
Mailing Address - Phone:610-252-6950
Mailing Address - Fax:610-252-8431
Practice Address - Street 1:30 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-2658
Practice Address - Country:US
Practice Address - Phone:610-252-6950
Practice Address - Fax:610-252-8431
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051114363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
50042074OtherCAPITAL BLUE CROSS
50042074OtherCAPITAL BLUE CROSS
PAP76495Medicare UPIN