Provider Demographics
NPI:1316194830
Name:HALLOCK, JENNIFER GERALD (NP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:GERALD
Last Name:HALLOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 E PARHAM RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4371
Mailing Address - Country:US
Mailing Address - Phone:804-346-2290
Mailing Address - Fax:804-346-3016
Practice Address - Street 1:7702 E PARHAM RD
Practice Address - Street 2:SUITE 106
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4371
Practice Address - Country:US
Practice Address - Phone:804-346-2290
Practice Address - Fax:804-346-3016
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167959363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner