Healthcare Provider Details

I. General information

NPI: 1447358577
Provider Name (Legal Business Name): JENNIFER LARSON KURRLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE LARSON NP

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 LAKE JAMES DR SUITE C
VIRGINIA BEACH VA
23464-6779
US

IV. Provider business mailing address

1109 FLOWER ST
VIRGINIA BEACH VA
23455-3883
US

V. Phone/Fax

Practice location:
  • Phone: 757-523-4589
  • Fax: 757-523-8920
Mailing address:
  • Phone: 202-271-1943
  • Fax: 757-523-8920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001182432
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166930
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: