Healthcare Provider Details

I. General information

NPI: 1073792792
Provider Name (Legal Business Name): JENNIFER LYNNE JENKS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE COURT SUITE 201
ASHBURN VA
20147
US

IV. Provider business mailing address

21785 FILIGREE COURT SUITE 201
ASHBURN VA
20147
US

V. Phone/Fax

Practice location:
  • Phone: 703-726-9930
  • Fax: 703-723-8283
Mailing address:
  • Phone: 703-726-9930
  • Fax: 703-723-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024167579
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: