Provider Demographics
NPI:1811471139
Name:CLINE, JESSICA TABOR (CPNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:TABOR
Last Name:CLINE
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2381 LONG MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-6423
Mailing Address - Country:US
Mailing Address - Phone:540-649-1616
Mailing Address - Fax:
Practice Address - Street 1:900A RIO EAST CT
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8040
Practice Address - Country:US
Practice Address - Phone:434-975-7777
Practice Address - Fax:434-975-7774
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA024176640363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics