Provider Demographics
NPI:1316618051
Name:ADKINS-HARRIS, JACQUELINE (FNP-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:ADKINS-HARRIS
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 TIDEWATER DR STE 19
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505-3700
Mailing Address - Country:US
Mailing Address - Phone:757-330-0150
Mailing Address - Fax:877-487-3044
Practice Address - Street 1:7525 TIDEWATER DR STE 19
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-3700
Practice Address - Country:US
Practice Address - Phone:757-330-0150
Practice Address - Fax:877-487-3044
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-22
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5015114363LF0000X
VA0024182737363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty