Provider Demographics
NPI:1245779776
Name:ALLY, JENNA M (MSN, AG-ACNP-BC)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:M
Last Name:ALLY
Suffix:
Gender:F
Credentials:MSN, AG-ACNP-BC
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:LOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 LEE ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:800-223-9173
Practice Address - Fax:434-243-6086
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174559363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care