Provider Demographics
NPI:1235486473
Name:JACKSON, JUDY GOLDSON (WHNP BC)
Entity type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:GOLDSON
Last Name:JACKSON
Suffix:
Gender:F
Credentials:WHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 S INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-4776
Mailing Address - Country:US
Mailing Address - Phone:757-471-6903
Mailing Address - Fax:757-471-3974
Practice Address - Street 1:2020 S INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-4776
Practice Address - Country:US
Practice Address - Phone:757-471-6903
Practice Address - Fax:757-471-3974
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024049242363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health