Provider Demographics
NPI:1750636270
Name:COTTER, JENIFER (NP)
Entity Type:Individual
Prefix:
First Name:JENIFER
Middle Name:
Last Name:COTTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3738 WINTERFIELD RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-9236
Mailing Address - Country:US
Mailing Address - Phone:804-378-9378
Mailing Address - Fax:
Practice Address - Street 1:2020 S INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-4776
Practice Address - Country:US
Practice Address - Phone:757-471-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-20
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170005363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006207731Medicaid
VA006201181Medicaid