Provider Demographics
NPI:1043860067
Name:HART, JENNIFER (DACM, AP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:DACM, AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1876 LONG BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3508
Mailing Address - Country:US
Mailing Address - Phone:214-534-4844
Mailing Address - Fax:
Practice Address - Street 1:1604 HILLTOP WEST EXECUTIVE CENTER
Practice Address - Street 2:220
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451
Practice Address - Country:US
Practice Address - Phone:757-350-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-12
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000961171100000X
FLAP4076171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist