Provider Demographics
NPI:1255504908
Name:SLAGLE, JAMIE (CRNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:TIPPENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1715 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3609
Mailing Address - Country:US
Mailing Address - Phone:703-816-4152
Mailing Address - Fax:703-527-1169
Practice Address - Street 1:1715 N GEORGE MASON DR
Practice Address - Street 2:SUITE 302
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3609
Practice Address - Country:US
Practice Address - Phone:703-816-4152
Practice Address - Fax:703-527-1169
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171415363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology