Provider Demographics
NPI:1336644814
Name:ZUCKERMAN, JESSICA (MSN, FNP-C, AGNP- C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:MSN, FNP-C, AGNP- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2309 NETTLEFORD WAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2894
Mailing Address - Country:US
Mailing Address - Phone:757-773-1637
Mailing Address - Fax:
Practice Address - Street 1:2309 NETTLEFORD WAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453
Practice Address - Country:US
Practice Address - Phone:757-773-1637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine