Provider Demographics
NPI:1790568749
Name:WOOLARD, DEA JENIECE (DNP)
Entity Type:Individual
Prefix:
First Name:DEA
Middle Name:JENIECE
Last Name:WOOLARD
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 RIDGE END RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1028
Mailing Address - Country:US
Mailing Address - Phone:757-214-4469
Mailing Address - Fax:
Practice Address - Street 1:1729 WILDWOOD DR STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3176
Practice Address - Country:US
Practice Address - Phone:757-938-3654
Practice Address - Fax:757-938-3658
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187794363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care