Provider Demographics
NPI:1962868596
Name:WOOLBRIGHT, JESSIELYN (PA-C)
Entity type:Individual
Prefix:
First Name:JESSIELYN
Middle Name:
Last Name:WOOLBRIGHT
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 1:2944 N 82ND ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5830
Mailing Address - Country:US
Mailing Address - Phone:302-858-8196
Mailing Address - Fax:
Practice Address - Street 1:770 THE CITY DR S
Practice Address - Street 2:SUITE 8000
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4900
Practice Address - Country:US
Practice Address - Phone:800-463-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1701363A00000X
AZ7755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant