Healthcare Provider Details

I. General information

NPI: 1033185087
Provider Name (Legal Business Name): ERIKA JAYNE PEARL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 STEVENS ST NORWALK HOSPITAL DEPARTMENT OF SURGERY
NORWALK CT
06850-3852
US

IV. Provider business mailing address

16 SUNNY RIDGE RD
EASTON CT
06612-1252
US

V. Phone/Fax

Practice location:
  • Phone: 203-852-2464
  • Fax:
Mailing address:
  • Phone: 203-820-4166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9103479
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number000984
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: