Healthcare Provider Details

I. General information

NPI: 1760765143
Provider Name (Legal Business Name): JAIME L MAGIN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAIME L FORNO FNP

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 11/27/2023
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45130 COLUMBIA PL
STERLING VA
20166-2500
US

IV. Provider business mailing address

24742 CLOCK TOWER SQ
ALDIE VA
20105-2976
US

V. Phone/Fax

Practice location:
  • Phone: 585-755-9200
  • Fax:
Mailing address:
  • Phone: 703-391-2030
  • Fax: 703-273-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169506
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: