Provider Demographics
NPI:1174399802
Name:JACKS, MERCEDES ISABEL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MERCEDES
Middle Name:ISABEL
Last Name:JACKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:MERCEDES
Other - Middle Name:ISABEL
Other - Last Name:VASQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1585 BARRINGTON RD STE 501
Mailing Address - Street 2:
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-5020
Mailing Address - Country:US
Mailing Address - Phone:847-490-8900
Mailing Address - Fax:
Practice Address - Street 1:1585 BARRINGTON RD STE 501
Practice Address - Street 2:
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-5020
Practice Address - Country:US
Practice Address - Phone:847-490-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085009854363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant