Healthcare Provider Details

I. General information

NPI: 1053580597
Provider Name (Legal Business Name): CAROLA (NONE) BRUFLAT RNC, MSN, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2008
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8501 ARLINGTON BLVD STE 300
FAIRFAX VA
22031-4625
US

IV. Provider business mailing address

9632 PODIUM DR
VIENNA VA
22182-3336
US

V. Phone/Fax

Practice location:
  • Phone: 703-560-1611
  • Fax:
Mailing address:
  • Phone: 703-255-9820
  • Fax: 703-319-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024079274
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: