Provider Demographics
NPI:1972928745
Name:ZUREICK, JACLYN NAOMI (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACLYN
Middle Name:NAOMI
Last Name:ZUREICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:JACLYN
Other - Middle Name:NAOMI
Other - Last Name:NUTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5 BEL AIR SOUTH PKWY
Mailing Address - Street 2:STE 1535
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-3816
Mailing Address - Country:US
Mailing Address - Phone:302-331-4604
Mailing Address - Fax:
Practice Address - Street 1:5 BEL AIR SOUTH PKWY
Practice Address - Street 2:SUITE 1535
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6091
Practice Address - Country:US
Practice Address - Phone:410-569-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2017-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005338363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant