Provider Demographics
NPI:1578912424
Name:KOLLAT, JENNA (PA)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KOLLAT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2300 FALL HILL AVE STE 509
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3343
Mailing Address - Country:US
Mailing Address - Phone:540-741-2277
Mailing Address - Fax:540-741-1029
Practice Address - Street 1:1101 SAM PERRY BLVD STE 211
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4465
Practice Address - Country:US
Practice Address - Phone:540-372-7792
Practice Address - Fax:540-372-2073
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDC06236363A00000X
VA0110005892363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant