Provider Demographics
NPI:1215569942
Name:DAFFER, JENNA MARIE (NP)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:DAFFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:BYOREK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:3040 WILLIAMS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:571-350-8400
Mailing Address - Fax:703-940-8692
Practice Address - Street 1:1100 N GLEBE RD STE 1600
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5798
Practice Address - Country:US
Practice Address - Phone:571-350-8400
Practice Address - Fax:703-528-0338
Is Sole Proprietor?:No
Enumeration Date:2020-02-11
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2019047604363LA2100X
VA0024186450363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30015880020002Medicaid
VA0870-0092OtherCAREFIRST BCBS
VA2384961OtherCIGNA