Individual
MRS. JESSICA FANTAZOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14904 JEFFERSON DAVIS HWY, SUITE 103, WOODBRIDGE, VA 22191-3908
(703) 497-4222
(703) 492-0164
Mailing address
14904 JEFFERSON DAVIS HWY, SUITE 103, WOODBRIDGE, VA 22191-3908
(703) 497-4222
(703) 492-0164
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002900
VA
Other
Enumeration date
07/08/2010
Last updated
07/08/2010
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