Provider Demographics
NPI:1457871196
Name:JACOBSON, ZACHARY C (PA-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:C
Last Name:JACOBSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 PENINSULA DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4169
Mailing Address - Country:US
Mailing Address - Phone:814-877-7290
Mailing Address - Fax:814-877-7280
Practice Address - Street 1:1101 PENINSULA DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4169
Practice Address - Country:US
Practice Address - Phone:814-877-7290
Practice Address - Fax:814-877-7280
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA059078363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant