Provider Demographics
NPI:1679521074
Name:MINK, JESSICA MARTINS (MPAS)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MARTINS
Last Name:MINK
Suffix:
Gender:F
Credentials:MPAS
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:MARTINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:43 SMITH ROAD
Mailing Address - Street 2:ATTN: PROF AFFAIRS, NAVAL HEALTH CARE NEW ENGLAND
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841-1002
Mailing Address - Country:US
Mailing Address - Phone:401-841-4522
Mailing Address - Fax:401-841-4128
Practice Address - Street 1:FORT BELVOIR COMMUNITY HOSPITAL, 9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:508-951-2648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA00397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN