Provider Demographics
NPI:1730348558
Name:EDDINS, JENELL (PA)
Entity type:Individual
Prefix:
First Name:JENELL
Middle Name:
Last Name:EDDINS
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:12200 WARWICK BLVD STE 310
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-2344
Practice Address - Country:US
Practice Address - Phone:757-534-9988
Practice Address - Fax:757-534-5688
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2022-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085-003231363A00000X
VA0110003087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant