Healthcare Provider Details

I. General information

NPI: 1619614328
Provider Name (Legal Business Name): JYKA NAVA BRAVO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2022
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3143 MAGIC HOLLOW BLVD STE 200
VIRGINIA BEACH VA
23453-3077
US

IV. Provider business mailing address

3143 MAGIC HOLLOW BLVD STE 200
VIRGINIA BEACH VA
23453-3077
US

V. Phone/Fax

Practice location:
  • Phone: 757-385-8222
  • Fax: 757-363-3438
Mailing address:
  • Phone: 757-385-8222
  • Fax: 757-363-3438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024184130
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: