Individual
LAURA ANN JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1950 GLENN MITCHELL DR STE 200, VIRGINIA BEACH, VA 23456-0168
(757) 507-0600
(757) 589-3785
Mailing address
1950 GLENN MITCHELL DR STE 200, VIRGINIA BEACH, VA 23456-0168
(757) 507-0600
(757) 589-3785
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024170719
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487995718
—
VA
Enumeration date
03/12/2013
Last updated
05/06/2024
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