Healthcare Provider Details

I. General information

NPI: 1124678495
Provider Name (Legal Business Name): NANCY PEREZ RAMIREZ FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2019
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13767 RESTINA RD
BRISTOW VA
20136-5788
US

IV. Provider business mailing address

13767 RESTINA RD
BRISTOW VA
20136-5788
US

V. Phone/Fax

Practice location:
  • Phone: 703-665-9488
  • Fax:
Mailing address:
  • Phone: 703-665-9488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1152392
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024178923
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: