Provider Demographics
NPI:1295162410
Name:BODIN, JENNIFER ANNE (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANNE
Last Name:BODIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6415 HOT SPRING LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-2576
Mailing Address - Country:US
Mailing Address - Phone:910-554-6616
Mailing Address - Fax:
Practice Address - Street 1:10600 SPOTSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-2637
Practice Address - Country:US
Practice Address - Phone:540-604-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily