Healthcare Provider Details

I. General information

NPI: 1629847397
Provider Name (Legal Business Name): JESSICA CANAVAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7051 HEATHCOTE VILLAGE WAY STE 230
GAINESVILLE VA
20155-3266
US

IV. Provider business mailing address

7051 HEATHCOTE VILLAGE WAY STE 230
GAINESVILLE VA
20155-3266
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-4200
  • Fax: 703-279-4201
Mailing address:
  • Phone: 571-472-4200
  • Fax: 703-279-4201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: