Provider Demographics
NPI:1003995200
Name:NORRIS, JACELYN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JACELYN
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 LINDEN DR
Mailing Address - Street 2:SUITE 154
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2894
Mailing Address - Country:US
Mailing Address - Phone:540-535-0777
Mailing Address - Fax:703-740-8317
Practice Address - Street 1:22895 BRAMBLETON PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-4876
Practice Address - Country:US
Practice Address - Phone:703-327-3173
Practice Address - Fax:703-740-8317
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002333363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1003995200Medicaid
VAP00667931OtherRR MEDICARE
VAVV4688AMedicare PIN
VA1003995200Medicaid