Provider Demographics
NPI:1689637449
Name:SEGARRA, JENNIFER LYNN (IDC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:SEGARRA
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 SHERMAN OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-5726
Mailing Address - Country:US
Mailing Address - Phone:757-444-2290
Mailing Address - Fax:
Practice Address - Street 1:USS NORMANDY (CG 60)
Practice Address - Street 2:
Practice Address - City:FPO AP
Practice Address - State:VA
Practice Address - Zip Code:92108-1190
Practice Address - Country:US
Practice Address - Phone:757-444-2290
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman