Provider Demographics
NPI:1750712568
Name:HENSARLING, JENNIFER (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HENSARLING
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 1:5275 LEE HWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-1619
Mailing Address - Country:US
Mailing Address - Phone:425-346-7129
Mailing Address - Fax:
Practice Address - Street 1:5275 LEE HWY STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207-1619
Practice Address - Country:US
Practice Address - Phone:425-346-7129
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-03
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178240363LF0000X
CA23774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA676617OtherCALIFORNIA BOARD OF REGISTERED NURSING, REGISTERED NURSE
VA0017146375OtherCOMMONWEALTH OF VIRGINIA DEPT OF HEALTH PROFESSIONS, AUTH TO PRESCRIBE
VA0001290094OtherCOMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS, RN
VA0024178240OtherCOMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS, NURSE PRACTITIONER
CA23774OtherCALIFORNIA BOARD OF REGISTERED NURSING, NURSE PRACTITIONER LICENSE & FURNISHING
WARN60052709OtherWASHINGTON STATE DEPARTMENT OF HEALTH, REGISTERED NURSE