Provider Demographics
NPI:1982793998
Name:SACRIPANTE, JUSTIN HENRY (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:HENRY
Last Name:SACRIPANTE
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 1:817 E GANNON AVE
Mailing Address - Street 2:
Mailing Address - City:ZEBULON
Mailing Address - State:NC
Mailing Address - Zip Code:27597-9309
Mailing Address - Country:US
Mailing Address - Phone:919-375-1975
Mailing Address - Fax:919-269-0240
Practice Address - Street 1:655 MAIN ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1699
Practice Address - Country:US
Practice Address - Phone:207-294-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA2173363AM0700X
NC0010-05956363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEPA2173OtherMAINE PA LICENSE