Provider Demographics
NPI:1023499647
Name:COLE, JEANNIE HA (PA)
Entity type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:HA
Last Name:COLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:JEANNIE
Other - Middle Name:
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1020 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5500
Mailing Address - Country:US
Mailing Address - Phone:757-464-1644
Mailing Address - Fax:757-363-1071
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-464-1644
Practice Address - Fax:757-363-1071
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical