Healthcare Provider Details

I. General information

NPI: 1598779191
Provider Name (Legal Business Name): JENNIFER SWISHER REAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. JENNIFER BLAKE SWISHER

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 KEMPSVILLE RD
NORFOLK VA
23502-3920
US

IV. Provider business mailing address

850 KEMPSVILLE RD
NORFOLK VA
23502-3920
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-3198
  • Fax: 757-388-4242
Mailing address:
  • Phone: 757-388-3198
  • Fax: 757-388-4242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA91599
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101241163
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036166161
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2019-02327
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: