Provider Demographics
NPI:1134356215
Name:HENKE, JODI ESKEN (PA-C)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:ESKEN
Last Name:HENKE
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 1:825 FAIRFAX AVE # 610
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1914
Mailing Address - Country:US
Mailing Address - Phone:757-446-8950
Mailing Address - Fax:
Practice Address - Street 1:850 KEMPSVILLE RD
Practice Address - Street 2:STE. 100G
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3920
Practice Address - Country:US
Practice Address - Phone:757-257-9913
Practice Address - Fax:757-466-0321
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002833363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant