Healthcare Provider Details

I. General information

NPI: 1154958544
Provider Name (Legal Business Name): JOERISSA GEARLDS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 TYSONS BLVD STE 300
MC LEAN VA
22102-4285
US

IV. Provider business mailing address

1701 N MENARD AVE
CHICAGO IL
60639-4120
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 773-759-1701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110011306
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: