Healthcare Provider Details

I. General information

NPI: 1306627450
Provider Name (Legal Business Name): JOYCE URBAN CPNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2023
Last Update Date: 10/12/2023
Certification Date: 10/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8081 INNOVATION PARK DR STE 765
FAIRFAX VA
22031-4867
US

IV. Provider business mailing address

11 FAIRMONT PL
STERLING VA
20165-5769
US

V. Phone/Fax

Practice location:
  • Phone: 571-472-1717
  • Fax:
Mailing address:
  • Phone: 571-239-4404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number0024188324
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024188324
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: