Mark Charles Jakubisin, PA
Physician Assistant in Charlotte, NC. Individual provider (NPI-1).
NPI number1891116331
StatusActive
Last updated in NPPESJul 25, 2024
Details
- NPI
- 1891116331
- Entity type
- Individual (NPI-1)
- Name
- Mark Charles Jakubisin
- Credential
- PA
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Dec 31, 2013
- Last updated
- Jul 25, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 0010-04704 | NC | Yes |
Practice location
1237 Harding PlSte 4300
Charlotte, NC 28204
Phone 704-373-0212
Mailing address
Po Box 19305Charlotte, NC 28219-9305
Other practice locations
10650 Park Rd
Charlotte, NC 28210-8538
Charlotte, NC 28210-8538
Phone 704-667-3840
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