Provider Demographics
NPI:1487600631
Name:JAZAYERI, ANNA-MARGARET CHAUNCEY (PA-C)
Entity type:Individual
Prefix:MS
First Name:ANNA-MARGARET
Middle Name:CHAUNCEY
Last Name:JAZAYERI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POB 602
Mailing Address - Street 2:
Mailing Address - City:HATTERAS
Mailing Address - State:NC
Mailing Address - Zip Code:27943
Mailing Address - Country:US
Mailing Address - Phone:252-347-6512
Mailing Address - Fax:
Practice Address - Street 1:57635 NC HWY 12
Practice Address - Street 2:
Practice Address - City:HATTERAS
Practice Address - State:NC
Practice Address - Zip Code:27943
Practice Address - Country:US
Practice Address - Phone:282-986-2756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC104023363AM0700X
FL9104636363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q19398Medicare UPIN