Provider Demographics
NPI:1689962177
Name:JOSLYN, JESSICA C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:C
Last Name:JOSLYN
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:PO BOX 960
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93421-0960
Mailing Address - Country:US
Mailing Address - Phone:415-994-0392
Mailing Address - Fax:
Practice Address - Street 1:180 LE POINT ST
Practice Address - Street 2:A & B
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2741
Practice Address - Country:US
Practice Address - Phone:805-481-3442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant