Individual
MR. JACOB STRANGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1300 SOUTH DRIVE, WINNEBAGO, WI 54985
(920) 235-4910
Mailing address
1521 CLIFFVIEW DR, OSHKOSH, WI 54901-2575
(330) 618-9628
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3818-23
WI
363A00000X
Physician Assistant
50.004667RX
OH
363A00000X
Physician Assistant
PA9109427
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3818-23
WISCONSIN LICENSE
WI
01
—
50.004667RX
OHIO LICENSE
OH
01
—
PA9109427
FLORIDA LICENSE
FL
Enumeration date
06/07/2016
Last updated
07/21/2023
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