Provider Demographics
NPI:1376829903
Name:BAUTISTA-GOGEL, JENNIFER JASMINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JASMINE
Last Name:BAUTISTA-GOGEL
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:10006 MARSHALL POND RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3709
Mailing Address - Country:US
Mailing Address - Phone:917-703-4201
Mailing Address - Fax:
Practice Address - Street 1:6020 RICHMOND HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22303-2157
Practice Address - Country:US
Practice Address - Phone:571-308-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant