Healthcare Provider Details

I. General information

NPI: 1386462224
Provider Name (Legal Business Name): ASHLEY VAZANA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2024
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 GLADE HILL RD
FAIRFAX VA
22031-3222
US

IV. Provider business mailing address

8900 GLADE HILL RD
FAIRFAX VA
22031-3222
US

V. Phone/Fax

Practice location:
  • Phone: 202-320-1136
  • Fax:
Mailing address:
  • Phone: 202-320-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024190582
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: