Michelle Marie Jacques, RN-BC,AGPCNP-BC,CMT

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

0024173383 Issued in VA

Practice address

10400 Eaton PL Ste 312
Fairfax, VA 22030-2208

Phone

(703) 615-8422

Fax

(833) 606-0558

NPI assigned

May 24, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in DC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michelle.jacques.1@22660.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/22660/brand/1/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Collaborative Pain Management, PLLC

  • Pain Medicine Physician
  • Fairfax, VA
  • NPI 1356947295

  DC

  Medicare reassignment NPD Authorized official
• Fitness and Rehabilitation, Inc.

  • Physical Therapy Clinic/Center
  • Fairfax, VA
  • NPI 1609211036
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1464048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741910400000",
    "number": "1194172726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10400 EATON PL STE 312",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302208",
            "telephone_number": "703-615-8422",
            "fax_number": "833-606-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10400 EATON PL STE 312",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220302208",
            "telephone_number": "703-615-8422",
            "fax_number": "833-606-0558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACQUES",
        "first_name": "MICHELLE",
        "middle_name": "MARIE",
        "credential": "RN-BC,AGPCNP-BC,CMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-24",
        "last_updated": "2025-03-14",
        "certification_date": "2025-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "VA",
            "license": "0019005354",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "0024173383",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "VA",
            "license": "0024173383",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024173383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cpmpllc@icloud.commmmm",
            "affiliation": "N",
            "endpointDescription": "business email",
            "address_1": "10400 Eaton Pl Ste 312",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220302208",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Nicole Jacobs, PT, DPT
• Jacqueline A Jacobson, L.P.C.
• Susan E. Jacobson, NP
• Suzyn Jacobson, LCSW
• Sylvia Jacoub, PSYD
• Jae Kim, MD PLC
• Maimunah Shah Jafer, CCC-SLP
• Rinku Patel Jagait, MD
• Kavita Jagarlamudi, M.D.
• Jaguar Integrative LLC

• Nurse Practitioner in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.