Provider Demographics
NPI:1982090510
Name:1ST CHOICE FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:1ST CHOICE FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:DAPHNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-922-8247
Mailing Address - Street 1:6177 GROVEDALE CT
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2553
Mailing Address - Country:US
Mailing Address - Phone:703-922-8247
Mailing Address - Fax:703-922-8197
Practice Address - Street 1:6177 GROVEDALE CT
Practice Address - Street 2:SUITE 100A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2553
Practice Address - Country:US
Practice Address - Phone:703-922-8247
Practice Address - Fax:703-922-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty