Provider Demographics
NPI:1356443915
Name:AVERY, JASMIN J (NP)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:J
Last Name:AVERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:JAO BUDLONG
Other - Last Name:CIELITO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUTIE 500
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5216
Mailing Address - Country:US
Mailing Address - Phone:703-641-9161
Mailing Address - Fax:703-645-0493
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUTIE 500
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5216
Practice Address - Country:US
Practice Address - Phone:703-641-9161
Practice Address - Fax:703-645-0493
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001106983163W00000X
VA0017138367363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
0011OtherCAREFIRST
5726OtherCAREFIRST
VAC08696Medicare ID - Type Unspecified
VA017896C88Medicare ID - Type Unspecified
5726OtherCAREFIRST
0011OtherCAREFIRST