Healthcare Provider Details

I. General information

NPI: 1689157406
Provider Name (Legal Business Name): JANNATUL SHAN HOQUE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3720 FARRAGUT AVE STE 103
KENSINGTON MD
20895-2110
US

IV. Provider business mailing address

209 MARKWOOD DR
STERLING VA
20165-5817
US

V. Phone/Fax

Practice location:
  • Phone: 240-540-5585
  • Fax:
Mailing address:
  • Phone: 703-400-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176482
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024176482
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: