Provider Demographics
NPI:1750637815
Name:DOERRLER, JESSICA F (PA-C)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:F
Last Name:DOERRLER
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 1:500 SHEPHERD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-713-7306
Mailing Address - Fax:336-713-7322
Practice Address - Street 1:500 SHEPHERD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-713-7306
Practice Address - Fax:336-713-7322
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106657363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007385100Medicaid
FLGM940YMedicare PIN