Healthcare Provider Details

I. General information

NPI: 1841708211
Provider Name (Legal Business Name): JENNIFER TOBOLA WHNP, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2018
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1122 N 25TH ST
RICHMOND VA
23223-5254
US

IV. Provider business mailing address

1122 N 25TH ST
RICHMOND VA
23223-5254
US

V. Phone/Fax

Practice location:
  • Phone: 804-508-6045
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024195144
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001257572
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: