Provider Demographics
NPI:1013422856
Name:AZZARA, JACLYN (PA-C)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:AZZARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1203 LANGHORNE NEWTOWN RD STE 226
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1224
Practice Address - Country:US
Practice Address - Phone:215-710-5522
Practice Address - Fax:215-710-5181
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA004390363A00000X
NJ25MP00457000363A00000X
PAMA059548363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant