Provider Demographics
NPI:1265261838
Name:DAIL, JADE ANDREA
Entity type:Individual
Prefix:
First Name:JADE
Middle Name:ANDREA
Last Name:DAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADE
Other - Middle Name:ANDREA
Other - Last Name:DAIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 S MALLORY ST APT 4103
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23663-1872
Mailing Address - Country:US
Mailing Address - Phone:210-438-2873
Mailing Address - Fax:
Practice Address - Street 1:200 S MALLORY ST APT 4103
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23663-1872
Practice Address - Country:US
Practice Address - Phone:210-438-2873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190606363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily