Provider Demographics
NPI:1619426236
Name:JENKINS, VICTORIA REGINA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:REGINA
Last Name:JENKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19580 HICKORY DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-8292
Mailing Address - Country:US
Mailing Address - Phone:540-718-7356
Mailing Address - Fax:
Practice Address - Street 1:101 WOODMARK ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:VA
Practice Address - Zip Code:22960-1246
Practice Address - Country:US
Practice Address - Phone:540-672-0793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173937363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVN815AMedicare PIN