Provider Demographics
NPI:1790921831
Name:THABET, JANITZA CORTES (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JANITZA
Middle Name:CORTES
Last Name:THABET
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JANITZA
Other - Middle Name:
Other - Last Name:CORTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5 NEPONSET ST FL CENTER12
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:508-852-0600
Mailing Address - Fax:
Practice Address - Street 1:123 SUMMER ST STE 590N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1216
Practice Address - Country:US
Practice Address - Phone:508-368-3179
Practice Address - Fax:508-368-3164
Is Sole Proprietor?:No
Enumeration Date:2008-12-19
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA4980363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301071OtherGROUP NUMBER