Individual
JACOB MARK CZAJKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4771 S CLEVELAND AVE, FORT MYERS, FL 33907-1317
(239) 343-9800
(239) 343-9848
Mailing address
PO BOX 2147, FORT MYERS, FL 33902-2147
(239) 343-9800
(239) 343-9848
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
5601010457
MI
363A00000X
Physician Assistant
Primary
PA9115985
FL
363AS0400X
Surgical Physician Assistant
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115551000
—
FL
01
—
C200356585308
MICHIGAN STATE LICENSE
MI
Enumeration date
08/28/2019
Last updated
11/09/2022
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