Provider Demographics
NPI:1225300031
Name:SYRACUSE, JENNIFER K (FNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:SYRACUSE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4633 36TH ST S APT A2
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1747
Mailing Address - Country:US
Mailing Address - Phone:703-200-3617
Mailing Address - Fax:
Practice Address - Street 1:1133 21ST ST NW FL 7
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3390
Practice Address - Country:US
Practice Address - Phone:202-416-2000
Practice Address - Fax:202-416-2007
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001032363LF0000X
VA0024169541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily