Individual
MICHELLE MARIE JACQUES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN-BC,AGPCNP-BC,CMT
Contact information
Practice address
10400 EATON PL STE 312, FAIRFAX, VA 22030-2208
(703) 615-8422
(833) 606-0558
Mailing address
10400 EATON PL STE 312, FAIRFAX, VA 22030-2208
(703) 615-8422
(833) 606-0558
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
0019005354
VA
363L00000X
Nurse Practitioner
Primary
0024173383
VA
363LA2200X
Adult Health Nurse Practitioner
0024173383
VA
363LG0600X
Gerontology Nurse Practitioner
0024173383
VA
Other
Enumeration date
05/24/2016
Last updated
03/14/2025
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