Healthcare Provider Details

I. General information

NPI: 1164772240
Provider Name (Legal Business Name): JAMIE E WOOD CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMIE E OTTAWAY ARNP

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7703
  • Fax:
Mailing address:
  • Phone: 757-668-7703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberARNP 9323648
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024177620
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: