Healthcare Provider Details

I. General information

NPI: 1134964588
Provider Name (Legal Business Name): JESSICA LEIGH GEIMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2024
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 BAYLOR CT STE 100
CHESAPEAKE VA
23320-3690
US

IV. Provider business mailing address

827 MONTEBELLO CIR
CHESAPEAKE VA
23322-7245
US

V. Phone/Fax

Practice location:
  • Phone: 757-991-0190
  • Fax:
Mailing address:
  • Phone: 904-864-4284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024190460
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: