Provider Demographics
NPI:1952349649
Name:RAJCIC, JO ANN (PA)
Entity type:Individual
Prefix:MS
First Name:JO
Middle Name:ANN
Last Name:RAJCIC
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 OLEANDER DR STE 201
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4722
Mailing Address - Country:US
Mailing Address - Phone:833-365-7246
Mailing Address - Fax:877-296-5238
Practice Address - Street 1:9 WALDEN RIDGE DR STE 10
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8592
Practice Address - Country:US
Practice Address - Phone:833-365-7246
Practice Address - Fax:877-296-5238
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11138363A00000X
SC2708363AM0700X
IL085.000597363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3932056OtherBLUE SHIELD
ILDA7587OtherRAILROAD MEDICARE GRP #
ILP00152699OtherRAILROAD MEDICARE #
ILR78376OtherUPIN #
213567Medicare PIN
ILK11034Medicare PIN
ILP00152699OtherRAILROAD MEDICARE #
IL214881009Medicare PIN
IL208107Medicare PIN
ILR78376OtherUPIN #
ILR78376Medicare UPIN
ILK11035Medicare PIN
IL209026Medicare PIN
IL3932056OtherBLUE SHIELD