Provider Demographics
NPI:1679100978
Name:FERNSLER, JARED (PA)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:FERNSLER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N SUMMIT ST FL 7
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-1531
Mailing Address - Country:US
Mailing Address - Phone:517-366-5000
Mailing Address - Fax:517-366-5002
Practice Address - Street 1:146 S CHARLES ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2556
Practice Address - Country:US
Practice Address - Phone:517-366-5000
Practice Address - Fax:517-366-5002
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI5601009961363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program