Jacqueline Elizabeth Tizol-Urena, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12955 Issued in GA

Practice address

301 Philip Blvd Ste a
Lawrenceville, GA 30046-8746

Phone

(770) 822-5560

Fax

(770) 822-4989

NPI assigned

May 3, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Morehouse School of Medicine, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aga, LLCGroup PAC ID 2365431350, 138 clinicians

Aga Professional Services LLCGroup PAC ID 3870768997, 175 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northside Hospital Gwinnett Hospital, Lawrenceville, GA, CCN 110087

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Interoperability endpoints

• Direct secure messaging: jacqueline.urena@ud.eclinicaldirectplus.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Aga Professional Services, LLC

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1063799120
  Medicare reassignment Care Compare group
• Aga, LLC

  • Gastroenterology Physician
  • Atlanta, GA
  • NPI 1124064118
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northside Hospital, Inc.

  • General Acute Care Hospital
  • Lawrenceville, GA
  • NPI 1952340994
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1683072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743638400000",
    "number": "1083303226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 PHILIP BLVD STE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468746",
            "telephone_number": "770-822-5560",
            "fax_number": "770-822-4989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 PHILIP BLVD STE A",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468746",
            "telephone_number": "770-822-5560",
            "fax_number": "770-822-4989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIZOL-URENA",
        "first_name": "JACQUELINE",
        "middle_name": "ELIZABETH",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-03",
        "last_updated": "2025-04-03",
        "certification_date": "2025-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12955",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bianca Tinord
• Detisha Bunnicole Tinsley
• Deepthi Tirunagari, MD
• Ephesian Tisdale, RBT
• Olivia Tishman, OTD, OTR/L
• TLC for Women
• TLN Professional Services II, PC
• TN Chiropractic Clinic, LLC
• TNT Consultants Incorporated
• To Nga Thi Dinh LLC

• Physician Assistant in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.