Healthcare Provider Details

I. General information

NPI: 1922767094
Provider Name (Legal Business Name): DEEPALI PATEL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S JOYCE ST APT 2535
ARLINGTON VA
22202-2075
US

IV. Provider business mailing address

PO BOX 2914
ARLINGTON VA
22202-0914
US

V. Phone/Fax

Practice location:
  • Phone: 301-789-5216
  • Fax:
Mailing address:
  • Phone: 301-789-5216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024183172
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024183172
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: