Provider Demographics
NPI:1689350977
Name:SAMUEL, JENNIFER HERBERGER (NP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HERBERGER
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20730 RUFFSDALE CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-2843
Mailing Address - Country:US
Mailing Address - Phone:571-212-2614
Mailing Address - Fax:
Practice Address - Street 1:531 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4115
Practice Address - Country:US
Practice Address - Phone:301-428-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-22
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186818207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine