Individual
ALEXA JAKACIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
301 E MAIN ST, BAY SHORE, NY 11706-8408
(631) 968-3000
Mailing address
4749 198TH ST, FLUSHING, NY 11358-3938
(917) 717-0433
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
10/04/2021
Last updated
10/04/2021
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