Provider Demographics
NPI:1720509599
Name:WEISSKOHL, JACK (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:WEISSKOHL
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23224-1925
Mailing Address - Country:US
Mailing Address - Phone:703-282-1297
Mailing Address - Fax:
Practice Address - Street 1:9950 COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:VA
Practice Address - Zip Code:23030-3434
Practice Address - Country:US
Practice Address - Phone:804-829-6600
Practice Address - Fax:804-829-6182
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2017-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily