Provider Demographics
NPI:1548346166
Name:MARCO, JACQUELINE R (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:R
Last Name:MARCO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:R
Other - Last Name:MARCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2320 WILMA RUDOLPH BLVD
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-5821
Mailing Address - Country:US
Mailing Address - Phone:931-645-1564
Mailing Address - Fax:931-645-3842
Practice Address - Street 1:2320 WILMA RUDOLPH BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-5821
Practice Address - Country:US
Practice Address - Phone:931-645-1564
Practice Address - Fax:931-645-3842
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000000158363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
3665117Medicare PIN