Provider Demographics
NPI:1922521293
Name:VEGA, JARED SCOTT (JD, APRN, RN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JARED
Middle Name:SCOTT
Last Name:VEGA
Suffix:
Gender:M
Credentials:JD, APRN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 W YORK ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1114
Mailing Address - Country:US
Mailing Address - Phone:718-938-0527
Mailing Address - Fax:
Practice Address - Street 1:439 W YORK ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1114
Practice Address - Country:US
Practice Address - Phone:718-938-0527
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-19
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN251444363LF0000X
VA0024180490363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily