Provider Demographics
NPI:1740522036
Name:JASTRZEBSKI, ALYSSA A (FNP)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:A
Last Name:JASTRZEBSKI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:A
Other - Last Name:GARRINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18427 THE COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7072
Mailing Address - Country:US
Mailing Address - Phone:803-622-0692
Mailing Address - Fax:
Practice Address - Street 1:308C MOCKSVILLE HWY
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-8267
Practice Address - Country:US
Practice Address - Phone:704-873-4484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5006115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily