Provider Demographics
NPI:1326417098
Name:SANSONE, JESSICA RENEE (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:SANSONE
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 1:311 W 24TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2668
Mailing Address - Country:US
Mailing Address - Phone:144-524-2148
Mailing Address - Fax:814-459-7823
Practice Address - Street 1:311 W 24TH ST STE 101
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2668
Practice Address - Country:US
Practice Address - Phone:814-452-4214
Practice Address - Fax:814-459-7823
Is Sole Proprietor?:No
Enumeration Date:2015-09-23
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057882363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1093733933OtherGROUP NPI