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Individual

JESSICA IRENE LAROSA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
890 W FARIS RD STE 310, GREENVILLE, SC 29605-4281
(864) 455-8300
(864) 455-8310
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8603

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4226
SC
363A00000X
Physician Assistant
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
PENDING
SC
Enumeration date
08/13/2020
Last updated
03/24/2022
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