Provider Demographics
NPI:1417387101
Name:SMITH, JOCELYN MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:MARIE
Last Name:SMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13135 LEE JACKSON MEMORIAL HWY STE 135
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1907
Mailing Address - Country:US
Mailing Address - Phone:703-961-0488
Mailing Address - Fax:703-961-9103
Practice Address - Street 1:13135 LEE JACKSON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1907
Practice Address - Country:US
Practice Address - Phone:703-961-0488
Practice Address - Fax:703-961-9103
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18564363LF0000X
MARN2297829363LP2300X
VA0024174888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care