Nicole Jack, PA-C

ActiveIndividual ProviderPhysician Assistant
NPI issued: May 15, 2018

Quick Facts

NPI Number
1083104137
TypeIndividual
StatusActive
SpecialtyPhysician Assistant
Taxonomy363A00000X — Physician Assistant
Phone
(815) 844-5343
StateIL

NPI Validation Status: Verified

✅Valid 10-digit NPI number (1083104137)
✅Active status confirmed
✅Verified by CMS NPPES Registry
✅HIPAA compliant identifier
✅Enumeration date on file (May 15, 2018)
Data source: CMS NPPES

Provider Overview

NICOLE JACK, PA-C is a Physician Assistant provider based in Pontiac, IL who has been registered with CMS since 2018. This NPI is currently Active under CMS NPPES registry.

Provider Details

NPI Number1083104137
Provider TypeIndividual Provider
GenderFemale
CredentialPA-C
StatusActive
Enumeration DateMay 15, 2018

Practice Location

CityPontiac
StateIL
ZIP Code61764
Phone(815) 844-5343

Specialties & Licenses

★ Primary
SpecialtyPhysician Assistant
Taxonomy Code363A00000X
License StateIL

Mailing Address

CityPontiac
StateIL
ZIP Code61764
Phone(815) 844-5343
Same as practice location

How to Use This NPI

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For Insurance Billing

Use NPI 1083104137 in Box 33 of the CMS-1500 claim form. This number is required by all major insurance carriers to identify the billing provider and process electronic medical claims.

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For Credentialing

Reference NPI 1083104137for provider credential verification. Hospital systems, state licensing boards, and CAQH directories query this number to verify the provider's active clinical status.

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For Patients

Share NPI 1083104137 with your insurance company. If you need to verify out-of-network benefits or file a reimbursement claim, your insurance provider will require this number to process it.

About Physician Assistant

Physician Assistants (PAs) practice medicine under the supervision of a licensed physician, conducting physical exams, diagnosing conditions, prescribing treatments, and assisting in surgeries.

Browse all Physician Assistantproviders →
📊
158,607
Physician Assistant Providers in the US

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People Also Ask

What is Nicole Jack's NPI number?
Nicole Jack's NPI number is 1083104137, a unique 10-digit identifier issued by the Centers for Medicare & Medicaid Services (CMS).
Is Nicole Jack's NPI currently active?
Yes, Nicole Jack's NPI status is Active as of the latest CMS NPPES database updates.
What does Nicole Jack specialize in?
Nicole Jack specializes in Physician Assistant. The healthcare taxonomy code associated with this specialty is 363A00000X.
Where does Nicole Jack practice?
Nicole Jack practices in Pontiac, IL 61764.
When was Nicole Jack's NPI issued?
Nicole Jack's NPI was issued on May 15, 2018.
What is Nicole Jack's provider type?
Nicole Jack is registered as an Individual Provider under CMS NPI Type 1.