Provider Demographics
NPI:1215061163
Name:BRANCH, JENNIFER A (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BRANCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N ROBINSON ST STE 200
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4460
Mailing Address - Country:US
Mailing Address - Phone:804-367-3777
Mailing Address - Fax:804-367-4209
Practice Address - Street 1:110 N ROBINSON ST STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4460
Practice Address - Country:US
Practice Address - Phone:804-367-3777
Practice Address - Fax:804-367-4209
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001133918163W00000X
VA0024185160363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO4867Medicare ID - Type Unspecified