Healthcare Provider Details

I. General information

NPI: 1265314066
Provider Name (Legal Business Name): RENIMOL PHILIP DNP, PMHNP-BC, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4528 INDIANA AVE
CHESAPEAKE VA
23321-2713
US

IV. Provider business mailing address

16713 SAYLEY DR
CHESTERFIELD VA
23832-2155
US

V. Phone/Fax

Practice location:
  • Phone: 757-381-6625
  • Fax: 757-891-6133
Mailing address:
  • Phone: 804-821-7688
  • Fax: 757-891-6133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number24193991
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: