Individual provider Active NPI

Christine Phan Jerabek, PA

  • Physician Assistant
  • Roseville, MN
National Provider Identifier
1619722329
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
14909 Issued in MN
Practice address
2720 Fairview Ave N Ste 200
Roseville, MN 55113-1306
Phone
(651) 633-6883
NPI assigned
Apr 17, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 14909 MN Primary
Physician Assistant 363A00000X 7902-23 WI

Addresses

Primary practice location

2720 Fairview Ave N Ste 200
Roseville, MN 55113-1306

Mailing address

2720 Fairview Ave N Ste 200
Roseville, MN 55113-1306
Phone (651) 633-6883

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240705002597 WI Practitioner - Physician Assistant 4486198082 Reassigns benefits to 1 organization
I20240809003829 MN Practitioner - Physician Assistant 4486198082 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
May accept Medicare assignment
Group practices
Tareen Dermatology PAGroup PAC ID 8123288156, 45 clinicians

Practice addresses (Care Compare)

2651 Hillcrest Dr
Suite 304
Hudson, WI 54016-9914
Phone (651) 633-6883

2720 Fairview Ave N
Suite 200
Roseville, MN 55113-1306

2770 Fairview Ave N
Roseville, MN 55113-1306
Phone (651) 633-6883

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
14909MNMDPhysician Assistant
7902-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tareen Dermatology, PA Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1713312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765411200000",
    "number": "1619722329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2720 FAIRVIEW AVE N STE 200",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131306",
            "telephone_number": "651-633-6883",
            "fax_number": "651-331-3459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2720 FAIRVIEW AVE N STE 200",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131306",
            "telephone_number": "651-633-6883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERABEK",
        "first_name": "CHRISTINE",
        "middle_name": "PHAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-04-17",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "14909",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "7902-23",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

Verify at the official NPI Registry.