Healthcare Provider Details

I. General information

NPI: 1902729411
Provider Name (Legal Business Name): AVEA WELLNESS & REJUVENATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8427 DORSEY CIR STE 101
MANASSAS VA
20110-4596
US

IV. Provider business mailing address

14497 POTOMAC MILLS RD STE 1004
WOODBRIDGE VA
22192-6807
US

V. Phone/Fax

Practice location:
  • Phone: 571-496-8333
  • Fax:
Mailing address:
  • Phone: 843-453-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA GASQUE
Title or Position: OWNER/PRACTITIONER
Credential: NP
Phone: 843-453-4839