Healthcare Provider Details

I. General information

NPI: 1538316500
Provider Name (Legal Business Name): TIA L. WASHINGTON R.N.C., W.H.N.P-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA L WASHINGTON-BENNETT R.N.C., W.H.N.P-BC

II. Dates (important events)

Enumeration Date: 08/21/2008
Last Update Date: 06/03/2022
Certification Date: 06/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE
HAMPTON VA
23665-2040
US

IV. Provider business mailing address

77 NEALY AVE
HAMPTON VA
23665-2040
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-7630
  • Fax:
Mailing address:
  • Phone: 757-225-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0001157255
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024166158
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: