Healthcare Provider Details

I. General information

NPI: 1114263977
Provider Name (Legal Business Name): TALI STOPAK-MATHIS FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 10/18/2023
Certification Date: 10/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 FAIRVIEW PARK DR STE 500
FALLS CHURCH VA
22042-4583
US

IV. Provider business mailing address

3180 FAIRVIEW PARK DR STE 50
FALLS CHURCH VA
22042-4583
US

V. Phone/Fax

Practice location:
  • Phone: 703-538-2066
  • Fax:
Mailing address:
  • Phone: 703-538-2066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCN1300584
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP46450
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: