Provider Demographics
NPI:1003883661
Name:SNOOK, JESSICA D (FNP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:D
Last Name:SNOOK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-5955
Mailing Address - Fax:757-446-5196
Practice Address - Street 1:825 FAIRFAX AVE
Practice Address - Street 2:118
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-5955
Practice Address - Fax:757-446-5196
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017138304363LF0000X
VA0001156770163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherMULTIPLAN
VAPAROtherCORVEL/CORCARE
VA-002 -003OtherTRICARE/CHAMPUS
NC7003995Medicaid
NC03995OtherNC BC/BS
VAPAROtherVIRGINIA PREMIER HEALTH
VAPAROtherUSA MANAGED CARE
VA010165393Medicaid
95827NOtherSENTARA / OPTIMA
VA010165393Medicaid
VAP00260771Medicare PIN