Healthcare Provider Details

I. General information

NPI: 1043101231
Provider Name (Legal Business Name): JENNA NICOLE RACCOR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2025
Last Update Date: 07/14/2025
Certification Date: 07/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 BABCOCK BLVD
PITTSBURGH PA
15237-5815
US

IV. Provider business mailing address

PO BOX 651
YOUNGSTOWN PA
15696-0651
US

V. Phone/Fax

Practice location:
  • Phone: 412-367-6700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA066829
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: