Healthcare Provider Details

I. General information

NPI: 1255200739
Provider Name (Legal Business Name): MRS. LETITIA ANN JANSSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 KEMPSVILLE RD BLDG A
NORFOLK VA
23502-4700
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-6550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110012082
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: