Healthcare Provider Details

I. General information

NPI: 1417387101
Provider Name (Legal Business Name): JOCELYN MARIE SMITH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13135 LEE JACKSON MEMORIAL HWY
FAIRFAX VA
22033-1907
US

IV. Provider business mailing address

13135 LEE JACKSON MEMORIAL HWY STE 135
FAIRFAX VA
22033-1907
US

V. Phone/Fax

Practice location:
  • Phone: 703-961-0488
  • Fax: 703-961-9103
Mailing address:
  • Phone: 703-961-0488
  • Fax: 703-961-9103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18564
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberRN2297829
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174888
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: