Provider Demographics
NPI:1962957928
Name:GROSTEFON, JESSI (PA-C)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:
Last Name:GROSTEFON
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 1:9149 ESTATE THOMAS STE 308
Mailing Address - Street 2:
Mailing Address - City:ST THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00802-3132
Mailing Address - Country:US
Mailing Address - Phone:340-774-8881
Mailing Address - Fax:
Practice Address - Street 1:9149 ESTATE THOMAS STE 308
Practice Address - Street 2:
Practice Address - City:ST THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802-3132
Practice Address - Country:US
Practice Address - Phone:340-774-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-19
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI103363AM0700X
CA53655363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical