Individual
MR. JACOB PATRICK WACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MMSC, PA-C
Contact information
Practice address
100 CHURCH ST S, NEW HAVEN, CT 06519-1703
(203) 432-4771
Mailing address
100 CHURCH ST S, NEW HAVEN, CT 06519-1703
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2026007576
MO
Other
Enumeration date
02/19/2026
Last updated
04/23/2026
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