Healthcare Provider Details

I. General information

NPI: 1235449497
Provider Name (Legal Business Name): STACY ANN BRINKLEY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22708 MAIN ST
COURTLAND VA
23837-1127
US

IV. Provider business mailing address

436 CLAIRMONT CT STE 105
COLONIAL HEIGHTS VA
23834-1765
US

V. Phone/Fax

Practice location:
  • Phone: 757-653-2007
  • Fax: 757-935-5551
Mailing address:
  • Phone: 757-562-2158
  • Fax: 757-562-2134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169005
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: