Provider Demographics
NPI:1194133983
Name:GEORGE, JESSICA ZULLO (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ZULLO
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:ZULLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4660 KENMORE AVE STE 1018
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1306
Mailing Address - Country:US
Mailing Address - Phone:571-483-1800
Mailing Address - Fax:703-823-5723
Practice Address - Street 1:4660 KENMORE AVE STE 1018
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1306
Practice Address - Country:US
Practice Address - Phone:571-483-1800
Practice Address - Fax:703-823-5723
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171851363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194133983Medicaid
VA489390ZAN3Medicare PIN