Provider Demographics
NPI:1831329895
Name:COOKE, JENNIFER JANSON (PA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:JANSON
Last Name:COOKE
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1072 LASKIN RD
Mailing Address - Street 2:STE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6387
Mailing Address - Country:US
Mailing Address - Phone:757-648-8605
Mailing Address - Fax:757-648-1363
Practice Address - Street 1:500 VIKING DR
Practice Address - Street 2:SUITE 200
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7477
Practice Address - Country:US
Practice Address - Phone:757-468-0550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2020-11-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110840782363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant