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General NPI Number Information
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NPI Number | 1568172831
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Entity Type | Individual
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Provider Name | JADE DENISE HASKINS FNP
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Gender | Female
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Dates
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Enumeration Date | 11/28/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 121 COURTHOUSE LN
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City | BOWLING GREEN
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State | VA
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Zip | 22427-9336
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Country | US
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Telephone | 804-633-5840
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Fax |
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Provider Business Mailing Address
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Address Line | 10508 ASPEN HIGHLANDS DR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553-4501
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Country | US
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Telephone | 540-287-7861
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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 | 0024185885
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License Number State | VA
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