Provider Demographics
NPI:1275280653
Name:JENNINGS, VICTORIA ANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ANNA
Last Name:JENNINGS
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 1:10 CHURCH AVE SW APT 502
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-2027
Mailing Address - Country:US
Mailing Address - Phone:804-972-0503
Mailing Address - Fax:
Practice Address - Street 1:10 CHURCH AVE SW APT 502
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24011-2027
Practice Address - Country:US
Practice Address - Phone:804-972-0503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant