Provider Demographics
NPI:1093476111
Name:ROSSELLI, JORDANNA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JORDANNA
Middle Name:
Last Name:ROSSELLI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JORDANNA
Other - Middle Name:DOMINIQUE
Other - Last Name:BADDELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1495 RIVER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95815-4517
Mailing Address - Country:US
Mailing Address - Phone:916-925-7020
Mailing Address - Fax:916-925-3680
Practice Address - Street 1:1495 RIVER PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95815-4517
Practice Address - Country:US
Practice Address - Phone:916-925-7020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-02
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA60816363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical