Healthcare Provider Details

I. General information

NPI: 1063989176
Provider Name (Legal Business Name): HELEN JORSKI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2018
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 E ROOSEVELT ST
PHOENIX AZ
85008-4973
US

IV. Provider business mailing address

191 N HARRIS DR
FORT RUCKER AL
36362-2344
US

V. Phone/Fax

Practice location:
  • Phone: 866-749-2876
  • Fax:
Mailing address:
  • Phone: 832-799-8660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA2290
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number7295
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: