Provider Demographics
NPI:1811409725
Name:BARZILLA, JORDAN AVERY (PA-C)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:AVERY
Last Name:BARZILLA
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 1:902 FROSTWOOD DR STE 269
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2388
Mailing Address - Country:US
Mailing Address - Phone:713-465-0696
Mailing Address - Fax:
Practice Address - Street 1:902 FROSTWOOD DR STE 269
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2388
Practice Address - Country:US
Practice Address - Phone:713-465-0696
Practice Address - Fax:713-465-7334
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-01
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant