Provider Demographics
NPI:1811722929
Name:GODWIN, JENNIFER E (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:GODWIN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 WILSON BLVD APT 317
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-3204
Mailing Address - Country:US
Mailing Address - Phone:571-643-1899
Mailing Address - Fax:
Practice Address - Street 1:3180 FAIRVIEW PARK DR STE 500
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-4583
Practice Address - Country:US
Practice Address - Phone:571-643-1899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169857363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner