Individual
JENNIFER BALLARD SQUIRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, BC (NURSEPRACT
Contact information
Practice address
8613 ROUTE 29 # 200N, FAIRFAX, VA 22031-2171
(571) 350-8400
(703) 280-9596
Mailing address
3040 WILLIAMS DR STE 100, FAIRFAX, VA 22031-4618
(571) 350-8400
(703) 280-9596
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
000121124
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001211124
VA RN LICENSE
VA
01
—
0024169800
NURSE PRACTITIONER LICENSE
VA
01
—
16322
CA NURSEPRACTIONERLICENSE
CA
01
—
669572
RN LICENSE
CA
01
—
AC000572
MD NP LICENSE
MD
Enumeration date
06/16/2006
Last updated
11/11/2025
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