Individual provider Active NPI

Jessica Zuckerman, MSN, FNP-C, AGNP- C

  • Family Medicine Physician
  • Virginia Beach, VA
National Provider Identifier
1336644814
Registry record updated Oct 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
95008009 Issued in CA
Practice address
2309 Nettleford Way
Virginia Beach, VA 23453
Phone
(757) 773-1637
NPI assigned
Mar 27, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 95008009 CA Primary

Addresses

Primary practice location

2309 Nettleford Way
Virginia Beach, VA 23453

Mailing address

2309 Nettleford Way
Virginia Beach, VA 23453-2894
Phone (757) 773-1637

Other practice location 1

385 Bridle Run Pl
Alpine, CA 91901-2630
Phone (757) 773-1637

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
95008009CAMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1522108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540080000000",
    "number": "1336644814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2309 NETTLEFORD WAY",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234532894",
            "telephone_number": "757-773-1637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2309 NETTLEFORD WAY",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "23453",
            "telephone_number": "757-773-1637"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "385 Bridle Run Pl",
            "address_purpose": "LOCATION",
            "city": "Alpine",
            "state": "CA",
            "postal_code": "919012630",
            "country_code": "US",
            "telephone_number": "757-773-1637",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZUCKERMAN",
        "first_name": "JESSICA",
        "credential": "MSN, FNP-C, AGNP- C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-27",
        "last_updated": "2018-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "95008009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.