Individual
JESSICA T. LEABO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
8081 INNOVATION PARK DR, FAIRFAX, VA 22031-4867
(571) 472-4724
(571) 472-0241
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002644
VA
363AM0700X
Medical Physician Assistant
0110002644
VA
Other
Enumeration date
11/01/2007
Last updated
08/31/2021
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