Provider Demographics
NPI:1639845118
Name:WILLSON, JENNIFER L (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:WILLSON
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 1:4001 PRINCE WILLIAM PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-7667
Mailing Address - Country:US
Mailing Address - Phone:703-792-6166
Mailing Address - Fax:
Practice Address - Street 1:4001 PRINCE WILLIAM PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7667
Practice Address - Country:US
Practice Address - Phone:703-792-6166
Practice Address - Fax:703-792-6833
Is Sole Proprietor?:No
Enumeration Date:2021-08-17
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181726363LC1500X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care