Healthcare Provider Details

I. General information

NPI: 1689962177
Provider Name (Legal Business Name): JESSICA C JOSLYN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2011
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 JAMES WAY STE 101
PISMO BEACH CA
93449-4974
US

IV. Provider business mailing address

PO BOX 101
ARROYO GRANDE CA
93421-0101
US

V. Phone/Fax

Practice location:
  • Phone: 805-858-0652
  • Fax: 805-291-8498
Mailing address:
  • Phone: 415-994-0392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: