Provider Demographics
NPI:1700282308
Name:HOLMQUIST, JESSICA L (PA-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:HOLMQUIST
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 1:15515 N REEMS RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9549
Mailing Address - Country:US
Mailing Address - Phone:623-544-1000
Mailing Address - Fax:
Practice Address - Street 1:15515 N REEMS RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-9549
Practice Address - Country:US
Practice Address - Phone:623-544-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-08
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6281363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty