Healthcare Provider Details

I. General information

NPI: 1891078549
Provider Name (Legal Business Name): PAULINA J MANCOSKE DNP, FNP-BC, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9404A MAIN ST
FAIRFAX VA
22031-4032
US

IV. Provider business mailing address

PO BOX 791775
BALTIMORE MD
21279-1775
US

V. Phone/Fax

Practice location:
  • Phone: 571-404-6974
  • Fax: 571-404-6975
Mailing address:
  • Phone: 571-302-5000
  • Fax: 571-302-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169626
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: