Individual
GINA DIANE JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8109 TIS WELL DRIVE, SUITE 511, ALEXANDRIA, VA 22306
(703) 799-9500
(703) 799-9502
Mailing address
8109 TIS WELL DRIVE, SUITE 511, ALEXANDRIA, VA 22306
(703) 799-9500
(703) 799-9502
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110-004038
VA
Other
Enumeration date
10/22/2012
Last updated
07/08/2021
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