Healthcare Provider Details

I. General information

NPI: 1447245733
Provider Name (Legal Business Name): EVA C ABRENICA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DRIVE FAIR OAKS HOSPITAL
FAIRFAX VA
22033
US

IV. Provider business mailing address

3998 FAIR RIDGE DRIVE SUITE 300
FAIRFAX VA
22033-2921
US

V. Phone/Fax

Practice location:
  • Phone: 703-295-9360
  • Fax: 703-295-9369
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number8789
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024166978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: