Provider Demographics
NPI:1184936908
Name:GRIMM, JENNA EMILY (LNP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:EMILY
Last Name:GRIMM
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20925 PROFESSIONAL PLZ STE 230
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3403
Mailing Address - Country:US
Mailing Address - Phone:703-621-7121
Mailing Address - Fax:703-665-7686
Practice Address - Street 1:10521 ROSEHAVEN ST
Practice Address - Street 2:SUITE LL 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2837
Practice Address - Country:US
Practice Address - Phone:703-281-5000
Practice Address - Fax:703-281-3491
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168872363LP0808X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health