Provider Demographics
NPI:1407462575
Name:GLASS, JODY LYNN (NP-C)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:LYNN
Last Name:GLASS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 BACK BAY LANDING RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23457-1338
Mailing Address - Country:US
Mailing Address - Phone:703-929-3302
Mailing Address - Fax:
Practice Address - Street 1:1567 BACK BAY LANDING RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23457-1338
Practice Address - Country:US
Practice Address - Phone:170-392-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily