Provider Demographics
NPI:1689126567
Name:BRACKETT, JOCELYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:BRACKETT
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 1:13105 WEATHERED OAK CT
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2943
Mailing Address - Country:US
Mailing Address - Phone:703-869-2228
Mailing Address - Fax:
Practice Address - Street 1:13105 WEATHERED OAK CT
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2943
Practice Address - Country:US
Practice Address - Phone:703-869-2228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174089363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily