Provider Demographics
NPI:1073824512
Name:JAMES, JAN ALICE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JAN
Middle Name:ALICE
Last Name:JAMES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JAN
Other - Middle Name:ALICE
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 COLISS AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-1742
Mailing Address - Country:US
Mailing Address - Phone:757-675-0295
Mailing Address - Fax:
Practice Address - Street 1:816 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6010
Practice Address - Country:US
Practice Address - Phone:757-363-6800
Practice Address - Fax:757-507-9023
Is Sole Proprietor?:No
Enumeration Date:2010-06-30
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003322363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant