Provider Demographics
NPI:1508623463
Name:TERRINI, JACQUELINE ELLA (PA)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELLA
Last Name:TERRINI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:ELLA
Other - Last Name:SAN JULE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 PONCE DE LEON PL UNIT 313
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-3253
Mailing Address - Country:US
Mailing Address - Phone:805-868-5859
Mailing Address - Fax:
Practice Address - Street 1:1968 PEACHTREE RD NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1281
Practice Address - Country:US
Practice Address - Phone:404-605-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program