Provider Demographics
NPI:1891311213
Name:ANAZA, JAE RYOUNG (FNP)
Entity Type:Individual
Prefix:
First Name:JAE
Middle Name:RYOUNG
Last Name:ANAZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 CHARLESTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3588
Mailing Address - Country:US
Mailing Address - Phone:618-967-3187
Mailing Address - Fax:
Practice Address - Street 1:3191 CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-3588
Practice Address - Country:US
Practice Address - Phone:618-967-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179369363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily