Provider Demographics
NPI:1033468087
Name:JORGENSON, SHARON ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ELIZABETH
Last Name:JORGENSON
Suffix:
Gender:F
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 1:3062 KINGSDALE CTR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2020
Mailing Address - Country:US
Mailing Address - Phone:614-484-1940
Mailing Address - Fax:
Practice Address - Street 1:3062 KINGSDALE CTR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2020
Practice Address - Country:US
Practice Address - Phone:614-484-1940
Practice Address - Fax:614-484-1941
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003559RX363AM0700X
OH003559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH123364Medicaid