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General NPI Number Information
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NPI Number | 1245523638
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Entity Type | Individual
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Provider Name | NINA LATASHA JERNIGAN FNP
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Gender | Female
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 1320 LASALLE AVE
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City | HAMPTON
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State | VA
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Zip | 23669-3801
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Country | US
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Telephone | 757-727-1820
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Fax |
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Provider Business Mailing Address
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Address Line | 924 SHORE DR
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City | NEWPORT NEWS
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State | VA
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Zip | 23607-6435
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Country | US
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Telephone | 757-503-3069
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024169403
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License Number State | VA
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