Healthcare Provider Details

I. General information

NPI: 1528333192
Provider Name (Legal Business Name): JESYKA D. L. GARLICH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 E WASHINGTON BLVD
CRESCENT CITY CA
95531-8397
US

IV. Provider business mailing address

780 E WASHINGTON BLVD
CRESCENT CITY CA
95531-8397
US

V. Phone/Fax

Practice location:
  • Phone: 707-464-6715
  • Fax:
Mailing address:
  • Phone: 707-464-6715
  • Fax: 707-464-6715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62224
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number9106513
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberAMD490
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: