Healthcare Provider Details

I. General information

NPI: 1679206494
Provider Name (Legal Business Name): TARA T SEAY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13737 SPOTSWOOD TRL
ELKTON VA
22827-3200
US

IV. Provider business mailing address

13737 SPOTSWOOD TRL
ELKTON VA
22827-3200
US

V. Phone/Fax

Practice location:
  • Phone: 540-713-4100
  • Fax: 757-579-8587
Mailing address:
  • Phone: 540-713-4100
  • Fax: 757-579-8587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAC004894
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185926
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001238969
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: