Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101252198 | VA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 0101252198 | VA |
N | 207R00000X | Internist | 0101252198 | VA |
N | 111NI0900X | Internist | 0101252198 | VA |
NPI | 1285894071 |
---|---|
Provider Name | Jocelyn C Ricasa |
First Address | Virginia Beach, VA 23462-7958 |
Second Address | Virginia Beach, VA 23462-7958 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2008 |
Last Update Date | 02/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30761 | (02) | VA |