Healthcare Provider Details

I. General information

NPI: 1528148343
Provider Name (Legal Business Name): RACHELL HART BREGANT PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RACHELL DIANO HART PHYSICIAN ASSISTANT

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 MOUNT PLEASANT RD SUITES 13 AND 14
CHESAPEAKE VA
23322-4043
US

IV. Provider business mailing address

1051 TRADEWINDS RD
VIRGINIA BEACH VA
23464-4404
US

V. Phone/Fax

Practice location:
  • Phone: 757-410-4580
  • Fax:
Mailing address:
  • Phone: 757-685-4599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001823
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: