Jaclyn Pine, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9112593 Issued in FL

Practice address

600 S Dixie Hwy Ste 103
Boca Raton, FL 33432-6034

Phone

(561) 806-6835

Fax

(561) 806-6607

NPI assigned

Nov 27, 2019

Last updated

Jan 9, 2020By the provider in NPPES

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

Other names 1

• Jackie Pine Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1574812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578528000000",
    "number": "1710523527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S DIXIE HWY STE 103",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334326034",
            "telephone_number": "561-430-3629",
            "fax_number": "561-990-7435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S DIXIE HWY STE 103",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334326034",
            "telephone_number": "561-806-6835",
            "fax_number": "561-806-6607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINE",
        "first_name": "JACLYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-27",
        "last_updated": "2020-01-09",
        "certification_date": "2020-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACKIE",
            "last_name": "PINE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Hema Radhakrishna Pillai, M.D.F.A.A.P.
• Emily Pillot
• Christine Pina, PT
• Pincus Plastic Surgery, PA
• David Jerard Pincus, M.D.
• Gena Pineda, DDS
• Adriana Pineros, FNP
• Roberto Pineyro, M.D.
• Phyllis Lanette Pinkard, NIC MASTER
• Marc Pinn, D.O.

• Physician Assistant in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.