Healthcare Provider Details

I. General information

NPI: 1316631922
Provider Name (Legal Business Name): SABA TASSAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 06/06/2023
Certification Date: 06/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GEORGE MASON DR
ARLINGTON VA
22205-3610
US

IV. Provider business mailing address

1430 DEERFIELD LN
WOODBRIDGE VA
22191-1011
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-6371
  • Fax:
Mailing address:
  • Phone: 571-477-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187205
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: