Provider Demographics
NPI:1285894071
Name:RICASA, JOCELYN C (MD)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:C
Last Name:RICASA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:828 HEALTHY WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-7958
Mailing Address - Country:US
Mailing Address - Phone:757-305-1797
Mailing Address - Fax:757-309-4715
Practice Address - Street 1:828 HEALTHY WAY STE 220-B
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-7958
Practice Address - Country:US
Practice Address - Phone:757-673-5860
Practice Address - Fax:757-673-5682
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252198207Q00000X, 207R00000X, 207QS0010X
PAMT196434390200000X
VA0116019374390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA30761Medicare UPIN