Provider Demographics
NPI:1144299199
Name:ZORICH, JENNIFER ELIZABETH (PA C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:ZORICH
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4101 JOHN DEERE RD
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-6790
Mailing Address - Country:US
Mailing Address - Phone:309-765-1600
Mailing Address - Fax:309-765-1610
Practice Address - Street 1:4101 JOHN DEERE RD
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-6790
Practice Address - Country:US
Practice Address - Phone:309-765-1600
Practice Address - Fax:309-765-1610
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001518363A00000X
IL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5100795OtherIA CONTROLLED SUBSTANCE