Healthcare Provider Details

I. General information

NPI: 1437567005
Provider Name (Legal Business Name): JESSICA DOGGETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 03/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2790 GODWIN BLVD STE 101
SUFFOLK VA
23434-8151
US

IV. Provider business mailing address

6350 CENTER DR STE 200
NORFOLK VA
23502-4107
US

V. Phone/Fax

Practice location:
  • Phone: 757-539-0670
  • Fax: 757-539-1062
Mailing address:
  • Phone: 757-213-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024171869
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: