Healthcare Provider Details

I. General information

NPI: 1285061465
Provider Name (Legal Business Name): JILLIAN KATHLEEN HOBBS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2013
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY STE 400
RESTON VA
20190-3219
US

IV. Provider business mailing address

PO BOX 75868 ORTHOVIRGINIA
BALTIMORE MD
21275-5868
US

V. Phone/Fax

Practice location:
  • Phone: 703-810-5202
  • Fax: 703-810-5420
Mailing address:
  • Phone: 703-383-6469
  • Fax: 703-385-1062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-004394
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: