Provider Demographics
NPI:1194884346
Name:SHOEMAKER, JACQUELINE A (RN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:A
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:A
Other - Last Name:POST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, FNP-BC
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2896
Mailing Address - Country:US
Mailing Address - Phone:154-053-6510
Mailing Address - Fax:540-450-8382
Practice Address - Street 1:3042 VALLEY AVE STE 106
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2669
Practice Address - Country:US
Practice Address - Phone:540-686-7224
Practice Address - Fax:540-450-8382
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001170503163W00000X
VA0024168202363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1194884346Medicaid
VA019120S14Medicare PIN