Provider Demographics
NPI:1295253185
Name:ARAICA, JACKLYN SARAH (PA-C)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:SARAH
Last Name:ARAICA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACKLYN
Other - Middle Name:SARAH
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2016 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3215
Mailing Address - Country:US
Mailing Address - Phone:910-581-2228
Mailing Address - Fax:
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28349-8801
Practice Address - Country:US
Practice Address - Phone:910-296-0941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06975363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0010-06975OtherNC MEDICAL BOARD LICENSE NUMBER