Provider Demographics
NPI:1811461403
Name:JORRIN, ALEXANDER TOBIAS (PA-C)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:TOBIAS
Last Name:JORRIN
Suffix:
Gender:M
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 1:146 W RIVER ST STE 11A
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2609
Mailing Address - Country:US
Mailing Address - Phone:401-606-8250
Mailing Address - Fax:401-519-2250
Practice Address - Street 1:146 W RIVER ST STE 11A
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-606-8250
Practice Address - Fax:401-519-2250
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA01084363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant