Provider Demographics
NPI:1063260875
Name:WATSON, JHANELLE (NP)
Entity type:Individual
Prefix:MS
First Name:JHANELLE
Middle Name:
Last Name:WATSON
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 1:999 WATERSIDE DR STE 2525
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-3316
Mailing Address - Country:US
Mailing Address - Phone:347-392-6438
Mailing Address - Fax:
Practice Address - Street 1:999 WATERSIDE DR STE 2525
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-3316
Practice Address - Country:US
Practice Address - Phone:347-392-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2024007071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily