Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jason Robert Hannibal, PA-C

Individual provider Physician Assistant · NPI 1043811201

Jason Robert Hannibal, PA-C is a Physician Assistant in Camp Lejeune, North Carolina. Qualified in 2021, 5 years ago. Works from 2 locations. Licensed in California and Connecticut.

Years since qualifying
5
Licensed in
CA, CT
In the registry since
2020
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

100 Brewster Blvd
Camp Lejeune, NC 28547-2575
Phone: (910) 450-4357
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 80 Seymour St, Hartford, CT 06102-8000 — (860) 972-0000

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 7250 (CT)
Physician Assistant Taxonomy 363A00000X · Licence 60480 (CA)

Record details

NPI number1043811201
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedNovember 4, 2020
Last updated in NPPESDecember 17, 2025
Certification dateDecember 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

Other providers in Camp Lejeune