Provider Demographics
NPI:1730849779
Name:JAGO, ANDREW J (PA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:JAGO
Suffix:
Gender:M
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 1:6676 KEITHCREST DR
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1229
Mailing Address - Country:US
Mailing Address - Phone:315-767-2784
Mailing Address - Fax:
Practice Address - Street 1:4405 N HOLLAND SYLVANIA RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3529
Practice Address - Country:US
Practice Address - Phone:567-803-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010625363A00000X
OH50.007559RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant