Healthcare Provider Details

I. General information

NPI: 1003593559
Provider Name (Legal Business Name): JENNIFER O'LAUGHLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD STE 209
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

11319 MCCAULIFF CT
NORTH CHESTERFIELD VA
23236-4822
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7804
  • Fax:
Mailing address:
  • Phone: 610-850-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06231554
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: