Provider Demographics
NPI:1396270310
Name:ORTEGA, JESSICA NICOLE (PA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:NICOLE
Last Name:ORTEGA
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3620 JOSEPH SIEWICK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1758
Mailing Address - Country:US
Mailing Address - Phone:703-391-0111
Mailing Address - Fax:
Practice Address - Street 1:3620 JOSEPH SIEWICK DR STE 201
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1758
Practice Address - Country:US
Practice Address - Phone:703-391-0111
Practice Address - Fax:703-391-0213
Is Sole Proprietor?:No
Enumeration Date:2017-04-27
Last Update Date:2019-12-23
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Provider Licenses
StateLicense IDTaxonomies
VA0110-005746363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical