Provider Demographics
NPI:1447358577
Name:KURRLE, JENNIFER LARSON (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LARSON
Last Name:KURRLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1109 FLOWER ST
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-3883
Mailing Address - Country:US
Mailing Address - Phone:202-271-1943
Mailing Address - Fax:757-523-8920
Practice Address - Street 1:1212 LAKE JAMES DR
Practice Address - Street 2:SUITE C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6779
Practice Address - Country:US
Practice Address - Phone:757-523-4589
Practice Address - Fax:757-523-8920
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001182432163W00000X
VA0024166930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse