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MRS. JESSICA FANTAZOS PA-C
NPI 1558673350
Physician Assistant - Medical in Woodbridge, VA

Active since July 08, 2010PECOS Enrolled
14904 JEFFERSON DAVIS HWY, SUITE 103, WOODBRIDGE, VA 22191(703) 497-4222(703) 492-0164 Get Directions Write a Review

NPPES record last updated: July 8, 2010. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Mrs. Jessica Fantazos Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MRS. JESSICA FANTAZOS PA-C (NPI 1558673350) is an individual medical provider in Woodbridge, Virginia, licensed in Virginia (0110002900) and active in the NPI registry since July 2010. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1558673350
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameMRS. JESSICA FANTAZOSCredential: PA-C
Location Address14904 JEFFERSON DAVIS HWY, SUITE 103Woodbridge, VA 22191-3908
Mailing Address14904 Jefferson Davis Hwy, Suite 103Woodbridge, VA 22191-3908 · (703) 497-4222 · Fax (703) 492-0164
Phone(703) 497-4222
Fax(703) 492-0164
Sole ProprietorNo
Enumeration DateJuly 8, 2010
✔ NPI 1558673350 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in VA · 0110002900
14904 JEFFERSON DAVIS HWY, Woodbridge, VA 22191
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Jessica Fantazos Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ALI JADIDI MD
Emergency Medicine
14904 JEFFERSON DAVIS HWY, SUITE 207
WOODBRIDGE, VA 22191
Prince William County (703) 492-1400
WOODBRIDGE INFERTILITY INSTITUTE
Clinic/Center
14904 JEFFERSON DAVIS HWY, DAVIS HIGHWAY
WOODBRIDGE, VA 22191
Prince William County (703) 494-0064
ARTHRITIS CARE CENTER PC
Internal Medicine (Rheumatology)
14904 JEFFERSON DAVIS HWY, SUITE 203
WOODBRIDGE, VA 22191
Prince William County (703) 492-6660
CARDIOVASCULAR CARE CENTER LLC
Internal Medicine (Cardiovascular Disease)
14904 JEFFERSON DAVIS HWY, 406
WOODBRIDGE, VA 22191
Prince William County (703) 492-0709
AARON FIGLER, O.D., & ASSOCIATES, P.C.
Optometrist
14904 JEFFERSON DAVIS HWY, STE 308
WOODBRIDGE, VA 22191
Prince William County (703) 494-3937
MOHAMMAD BAHADORI M.D.
Internal Medicine (Rheumatology)
14904 JEFFERSON DAVIS HWY, SUITE 203
WOODBRIDGE, VA 22191
Prince William County (703) 492-6660
PRIME WELLNESS CLINIC LLC
Clinic/Center (Primary Care)
14904 JEFFERSON DAVIS HWY, SUITE 305
WOODBRIDGE, VA 22191
Prince William County (571) 492-7702
EXCEL MEDICAL CLINIC, INC.
Clinic/Center (Primary Care)
14904 JEFFERSON DAVIS HWY, SUITE 205
WOODBRIDGE, VA 22191
Prince William County (703) 497-4500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jessica Fantazos's NPI number?

The NPI number for Jessica Fantazos is 1558673350. It was assigned to this individual provider in the NPPES registry on July 8, 2010.

Where is Jessica Fantazos located?

Jessica Fantazos practices at 14904 Jefferson Davis Hwy Suite 103, Woodbridge, VA 22191. The listed phone number is (703) 497-4222.

What is Jessica Fantazos's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Jessica Fantazos enrolled in Medicare?

Yes. Jessica Fantazos is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jessica Fantazos was last updated on July 8, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.