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General NPI Number Information
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NPI Number | 1902729411
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Entity Type | Organization
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Legal Business Name | AVEA WELLNESS & REJUVENATION
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Dates
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Enumeration Date | 08/01/2026
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Last Update Date | 08/01/2026
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Provider Practice Location Address
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Address Line | 8427 DORSEY CIR STE 101
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City | MANASSAS
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State | VA
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Zip | 20110-4596
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Country | US
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Telephone | 571-496-8333
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Fax |
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Provider Business Mailing Address
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Address Line | 14497 POTOMAC MILLS RD STE 1004
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City | WOODBRIDGE
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State | VA
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Zip | 22192-6807
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Country | US
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Telephone | 843-453-4839
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Fax |
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Authorized Official
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Title or Position | OWNER/PRACTITIONER
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Name | JESSICA GASQUE
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Credential | NP
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Telephone | 843-453-4839
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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 |
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License Number State |
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