Provider Demographics
NPI:1013565662
Name:GOFFE, JENNA (FNP)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:GOFFE
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 1:1200 N ROLFE ST APT 406
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-3368
Mailing Address - Country:US
Mailing Address - Phone:703-966-9428
Mailing Address - Fax:
Practice Address - Street 1:22895 BRAMBLETON PLZ STE 200
Practice Address - Street 2:
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-4878
Practice Address - Country:US
Practice Address - Phone:703-722-2312
Practice Address - Fax:703-722-2317
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily