Healthcare Provider Details

I. General information

NPI: 1386163475
Provider Name (Legal Business Name): DANA COLVIN AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21170 ASHBY PONDS BLVD
ASHBURN VA
20147
US

IV. Provider business mailing address

2 UNIVERSITY PLZ STE 204
HACKENSACK NJ
07601-6211
US

V. Phone/Fax

Practice location:
  • Phone: 571-291-6131
  • Fax: 571-291-6135
Mailing address:
  • Phone: 551-295-8223
  • Fax: 571-291-6135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0001182544
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: