Provider Demographics
NPI:1124879150
Name:JESSUP, BRITTANI DANIELLE (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRITTANI
Middle Name:DANIELLE
Last Name:JESSUP
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15004 WILKINSON RD
Mailing Address - Street 2:
Mailing Address - City:DEWITT
Mailing Address - State:VA
Mailing Address - Zip Code:23840-3217
Mailing Address - Country:US
Mailing Address - Phone:804-894-3566
Mailing Address - Fax:
Practice Address - Street 1:3628 BOULEVARD
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1342
Practice Address - Country:US
Practice Address - Phone:804-526-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-28
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189948363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily