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General NPI Number Information
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NPI Number | 1972837391
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Entity Type | Individual
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Provider Name | AMNA NASAR JADALI PAC
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Gender | Female
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Dates
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Enumeration Date | 10/01/2009
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Last Update Date | 04/12/2025
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Provider Practice Location Address
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Address Line | 550 BROADVIEW AVE STE 102
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City | WARRENTON
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State | VA
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Zip | 20186-2036
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Country | US
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Telephone | 540-680-3433
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Fax |
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Provider Business Mailing Address
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Address Line | 19490 SANDRIDGE WAY STE 210
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City | LEESBURG
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State | VA
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Zip | 20176-3467
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Country | US
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Telephone | 631-383-1014
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C05186
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 23 013606
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA030879
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110004039
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License Number State | VA
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