Provider Demographics
NPI:1013156926
Name:PATACSIL, JASON ALLAN (CRNA)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:ALLAN
Last Name:PATACSIL
Suffix:
Gender:M
Credentials:CRNA
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Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2575
Mailing Address - Country:US
Mailing Address - Phone:910-450-4785
Mailing Address - Fax:910-450-4790
Practice Address - Street 1:100 BREWSTER BLVD
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-2575
Practice Address - Country:US
Practice Address - Phone:910-450-4785
Practice Address - Fax:910-450-4790
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-17
Last Update Date:2019-10-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC257568367500000X
IL041-302032163WC0200X
FL9291172367500000X
IL209-008050367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine