Provider Demographics
NPI:1447765573
Name:FIELDS, JENNIFER LATASHA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LATASHA
Last Name:FIELDS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LATASHA
Other - Last Name:BUGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 440210
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0210
Mailing Address - Country:US
Mailing Address - Phone:615-824-3737
Mailing Address - Fax:
Practice Address - Street 1:200 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9274
Practice Address - Country:US
Practice Address - Phone:240-686-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175674363LF0000X
VA1003310798363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily