Healthcare Provider Details

I. General information

NPI: 1649289075
Provider Name (Legal Business Name): JACQUELINE JESSICA DOYLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA J DOYLE PA-C

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 PASEO DE PERALTA
SANTA FE NM
87501-4391
US

IV. Provider business mailing address

804 DON GASPAR AVE
SANTA FE NM
87505-2632
US

V. Phone/Fax

Practice location:
  • Phone: 505-577-0369
  • Fax:
Mailing address:
  • Phone: 505-577-0369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number82-PA005
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: