Provider Demographics
NPI:1922027671
Name:BURKE, JENNIFER MCGLONE (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MCGLONE
Last Name:BURKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 GRESHAM DR STE 8600
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1904
Mailing Address - Country:US
Mailing Address - Phone:757-388-6005
Mailing Address - Fax:757-388-6006
Practice Address - Street 1:600 GRESHAM DR STE 8600
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-6005
Practice Address - Fax:757-388-6006
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002161363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10005601POtherOPTIMA HEALTH
VA139178OtherBCBS OF VA
VA10005601POtherSENTARA
VA1922027671Medicaid
VAP00844142OtherRAILROAD MEDICARE
VA10005601POtherSENTARA
009175M60Medicare ID - Type Unspecified
VA139178OtherBCBS OF VA