Individual
MS. LISSET VANESSA JARQUIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1860 TOWN CENTER DRIVE, SUITE 150, RESTON, VA 20190-5905
(703) 480-0220
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110009449
VA
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1396429221
—
VA
05
—
3001766998001
—
VA
Enumeration date
06/12/2023
Last updated
10/18/2023
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