Healthcare Provider Details

I. General information

NPI: 1457735276
Provider Name (Legal Business Name): PAULA VIGILANTE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9782 HWY 903
BRACEY VA
23919-1991
US

IV. Provider business mailing address

9782 HWY 903
BRACEY VA
23919-1991
US

V. Phone/Fax

Practice location:
  • Phone: 434-636-6903
  • Fax: 434-636-3826
Mailing address:
  • Phone: 434-636-6903
  • Fax: 434-636-3826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172728
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: