Healthcare Provider Details

I. General information

NPI: 1184610594
Provider Name (Legal Business Name): RACHEL R COLQUITT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS RACHEL A RAUSCHBERG

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43300 SOUTHERN WALK PLZ SUITE 100
BROADLANDS VA
20148-4463
US

IV. Provider business mailing address

PO BOX 17334
BALTIMORE MD
21297-1334
US

V. Phone/Fax

Practice location:
  • Phone: 571-252-7353
  • Fax: 571-223-1797
Mailing address:
  • Phone: 703-443-6717
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024165668
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: