Healthcare Provider Details

I. General information

NPI: 1225300031
Provider Name (Legal Business Name): JENNIFER K. SYRACUSE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2012
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1133 21ST ST NW FL 7
WASHINGTON DC
20036-3390
US

IV. Provider business mailing address

4633 36TH ST S APT A2
ARLINGTON VA
22206-1747
US

V. Phone/Fax

Practice location:
  • Phone: 202-416-2000
  • Fax: 202-416-2007
Mailing address:
  • Phone: 703-200-3617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC001032
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169541
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: