Provider Demographics
NPI:1710475694
Name:STREET, JENNIFER CAROL (ARPN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CAROL
Last Name:STREET
Suffix:
Gender:F
Credentials:ARPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2501 N GLEBE RD STE 303
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-3558
Mailing Address - Country:US
Mailing Address - Phone:703-841-1436
Mailing Address - Fax:703-841-1315
Practice Address - Street 1:2501 N GLEBE RD STE 303
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-3558
Practice Address - Country:US
Practice Address - Phone:703-841-1436
Practice Address - Fax:703-841-1315
Is Sole Proprietor?:No
Enumeration Date:2018-04-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024182817363LP0808X
MDR216939363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health