| Doctor Name: | DR. JESSIE MARIE SURLA |
| NPI Number: | 1245656479 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DNP, BC- FNP |
| License Number: | CNP-02365 |
| Business Practice Address: | 204 Angelina Chaparral, NM - 880817558 |
| Business Phone Number: | 5758248100 |
| Business Fax Number: | |
| Mailing Address: | 204 Angelina, CHAPARRAL |
| State: | NM |
| Postal Code: | 880817558 |
| Phone Number: | 5758248100 |
| Fax Number: | |
| NPI Enumeration Date: | 03/12/2014 |
| NPI Last Update Date: | 10/02/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | CNP-02365 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |