Healthcare Provider Details

I. General information

NPI: 1245076512
Provider Name (Legal Business Name): JENNIFER FLORES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 FAIRFAX DR STE 400
ARLINGTON VA
22203-5860
US

IV. Provider business mailing address

3803 FAIRFAX DR STE 400
ARLINGTON VA
22203-5860
US

V. Phone/Fax

Practice location:
  • Phone: 703-738-4380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number0110010822
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: