Healthcare Provider Details

I. General information

NPI: 1043252125
Provider Name (Legal Business Name): JACQUELINE CURTIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 AVON ST SUITE 9
CHARLOTTESVILLE VA
22902-5750
US

IV. Provider business mailing address

310 AVON ST STE 9
CHARLOTTESVILLE VA
22902-5750
US

V. Phone/Fax

Practice location:
  • Phone: 434-817-1818
  • Fax: 434-817-9607
Mailing address:
  • Phone: 434-817-1818
  • Fax: 434-817-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024125896
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: