Provider Demographics
NPI:1053515262
Name:SISTO, JOCELIN (PA-C)
Entity type:Individual
Prefix:
First Name:JOCELIN
Middle Name:
Last Name:SISTO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JOCELIN
Other - Middle Name:
Other - Last Name:BATTISTIONI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7009
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-7009
Mailing Address - Country:US
Mailing Address - Phone:708-579-0018
Mailing Address - Fax:708-354-0264
Practice Address - Street 1:5201 WILLOW SPRINGS RD STE 380
Practice Address - Street 2:
Practice Address - City:LA GRANGE HIGHLANDS
Practice Address - State:IL
Practice Address - Zip Code:60525-6539
Practice Address - Country:US
Practice Address - Phone:708-579-0018
Practice Address - Fax:708-354-0264
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-002605363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL403270OtherGROUP PTAN
CN4921OtherRRMC