Provider Demographics
NPI:1275829475
Name:GILLMAN, JESSICA L (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:L
Last Name:GILLMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNN
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:104 WIDGEON DR
Mailing Address - Street 2:
Mailing Address - City:CURRITUCK
Mailing Address - State:NC
Mailing Address - Zip Code:27929-9628
Mailing Address - Country:US
Mailing Address - Phone:910-331-0314
Mailing Address - Fax:
Practice Address - Street 1:1144 N ROAD STREEAT
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-0000
Practice Address - Country:US
Practice Address - Phone:252-335-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-26
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01695207R00000X, 207P00000X
VA0102207591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine