Provider Demographics
NPI:1962622654
Name:MOSS, JEANNINE M (FNP)
Entity type:Individual
Prefix:
First Name:JEANNINE
Middle Name:M
Last Name:MOSS
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:5855 BREMO RD
Mailing Address - Street 2:SUITE 506
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1926
Mailing Address - Country:US
Mailing Address - Phone:804-285-3225
Mailing Address - Fax:804-285-0360
Practice Address - Street 1:5855 BREMO RD
Practice Address - Street 2:SUITE 506
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1926
Practice Address - Country:US
Practice Address - Phone:804-285-3225
Practice Address - Fax:804-285-0360
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-03-12
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Provider Licenses
StateLicense IDTaxonomies
VA0017137123363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06695OtherGROUP PTAN