Healthcare Provider Details

I. General information

NPI: 1952397234
Provider Name (Legal Business Name): JANE JERNIGAN MILLER APRN BC FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARTHA JANE COURTNEY

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/16/2012
Certification Date:
Deactivation Date: 07/17/2007
Reactivation Date: 07/20/2007

III. Provider practice location address

1215 LEE ST UNIVERSITY OF VIRGINIA HEALTH SYSTEM
CHARLOTTESVILLE VA
22908-0816
US

IV. Provider business mailing address

321 PLEASANT PL
CHARLOTTESVILLE VA
22911-2212
US

V. Phone/Fax

Practice location:
  • Phone: 434-243-4849
  • Fax:
Mailing address:
  • Phone: 434-975-9912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number605919
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0971-0209
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164858
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: