MEDICARE: JACKLYN SARAH ARAICA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0010-06975	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0010-06975	OTHER	NC	NC MEDICAL BOARD LICENSE NUMBER

General Provider Information

NPI Number	:	1295253185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKLYN SARAH ARAICA PA-C

Provider Business Mailing Address
First Line	:	2016 HERITAGE LN
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-3215
Country	:	US
Telephone Number	:	910-581-2228
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 N MAIN ST
Second Line	:
City	:	KENANSVILLE
State	:	NC
Zip	:	28349-8801
Country	:	US
Telephone Number	:	910-296-0941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2017
Last Update Date	:	01/12/2022

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