Healthcare Provider Details

I. General information

NPI: 1720509599
Provider Name (Legal Business Name): JACK WEISSKOHL MSN, FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 07/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9950 COURTHOUSE RD
CHARLES CITY VA
23030-3434
US

IV. Provider business mailing address

3101 MIDLOTHIAN TPKE
RICHMOND VA
23224-1925
US

V. Phone/Fax

Practice location:
  • Phone: 804-829-6600
  • Fax: 804-829-6182
Mailing address:
  • Phone: 703-282-1297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024175030
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: