# JACOB MARK CZAJKA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1659929123
- **Gender:** Man
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 5601010457 | MI | — |
| 363A00000X | Physician Assistant | PA9115985 | FL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | NY | — |

## Other

- **Enumeration date:** 08/28/2019
- **Last updated:** 11/09/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 115551000 | — | FL |
| 01 | — | C200356585308 | MICHIGAN STATE LICENSE | MI |