Healthcare Provider Details

I. General information

NPI: 1538048012
Provider Name (Legal Business Name): INNOVATED HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2025
Last Update Date: 10/19/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 RIDGE END RD
VIRGINIA BEACH VA
23454-1028
US

IV. Provider business mailing address

2035 RIDGE END RD
VIRGINIA BEACH VA
23454-1028
US

V. Phone/Fax

Practice location:
  • Phone: 757-214-4469
  • Fax:
Mailing address:
  • Phone: 757-214-4469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DEA JENIECE WOOLARD
Title or Position: NURSE PRACTITIONER/ OWNER
Credential: DNP-BC AND PMHNP
Phone: 757-214-4469