Healthcare Provider Details

I. General information

NPI: 1124595103
Provider Name (Legal Business Name): JOHANNA LYNN GASKINS DNP, APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 07/15/2023
Certification Date: 07/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10040 PENTLAND HILLS WAY
BRISTOW VA
20136-2665
US

IV. Provider business mailing address

10040 PENTLAND HILLS WAY
BRISTOW VA
20136-2665
US

V. Phone/Fax

Practice location:
  • Phone: 202-497-8348
  • Fax: 703-995-0930
Mailing address:
  • Phone: 202-497-8348
  • Fax: 703-952-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024176770
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: