Provider Demographics
NPI:1710343686
Name:BRABEC, JACLYN SARA (PA-C)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:SARA
Last Name:BRABEC
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 1:20201 N SCOTTSDALE HEALTHCARE DR STE 260
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4140
Mailing Address - Country:US
Mailing Address - Phone:480-398-1550
Mailing Address - Fax:480-398-1551
Practice Address - Street 1:20201 N SCOTTSDALE HEALTHCARE DR STE 260
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4140
Practice Address - Country:US
Practice Address - Phone:480-398-1550
Practice Address - Fax:480-398-1551
Is Sole Proprietor?:No
Enumeration Date:2016-01-07
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10365363A00000X
IDPA-1337363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT12330762-1206OtherLICENSE