Provider Demographics
NPI:1972028959
Name:JERNIGAN, URSULA RENEE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:URSULA
Middle Name:RENEE
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:URSULA
Other - Middle Name:RENEE
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 EASTHILL CT
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23664-1546
Mailing Address - Country:US
Mailing Address - Phone:757-850-0760
Mailing Address - Fax:
Practice Address - Street 1:100 EMANCIPATION DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23667-0001
Practice Address - Country:US
Practice Address - Phone:757-722-9961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2017-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily