Provider Demographics
NPI:1255504908
Name:SLAGLE, JAMIE (CRNP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:SLAGLE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:TIPPENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5400 CHESHIRE MEADOWS WAY
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-3216
Mailing Address - Country:US
Mailing Address - Phone:505-967-5761
Mailing Address - Fax:
Practice Address - Street 1:1031 STERLING RD STE 203
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3873
Practice Address - Country:US
Practice Address - Phone:703-466-5150
Practice Address - Fax:703-649-3599
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171415363LX0001X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology