MEDICARE: VICTORIA REGINA JENKINS FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024173937	VA

General Provider Information

NPI Number	:	1619426236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA REGINA JENKINS FNP-BC

Provider Business Mailing Address
First Line	:	19580 HICKORY DR
Second Line	:
City	:	CULPEPER
State	:	VA
Zip	:	22701-8292
Country	:	US
Telephone Number	:	540-718-7356
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 WOODMARK ST
Second Line	:
City	:	ORANGE
State	:	VA
Zip	:	22960-1246
Country	:	US
Telephone Number	:	540-672-0793
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2016
Last Update Date	:	04/06/2017

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