Provider Demographics
NPI:1063405686
Name:BROWN, JENNIFER FIELD (PHM-CNS/ NP)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:FIELD
Last Name:BROWN
Suffix:
Gender:F
Credentials:PHM-CNS/ NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1072 LASKIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6364
Mailing Address - Country:US
Mailing Address - Phone:757-648-8605
Mailing Address - Fax:757-648-1363
Practice Address - Street 1:1072 LASKIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-6364
Practice Address - Country:US
Practice Address - Phone:757-648-8605
Practice Address - Fax:757-648-1363
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000720364SP0808X
VA0024168259363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAO87933OtherOPTIMA/ SENTARA
VA005510961Medicaid
VA437209OtherANTHEM
VA005510961Medicaid