Healthcare Provider Details

I. General information

NPI: 1710145339
Provider Name (Legal Business Name): MARSABETH AMHAYES FLOYD FAMILY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 12/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 ELDEN STREET
HERNDON VA
20170-3128
US

IV. Provider business mailing address

1141 ELDEN ST STE 300
HERNDON VA
20170-5572
US

V. Phone/Fax

Practice location:
  • Phone: 240-687-4654
  • Fax:
Mailing address:
  • Phone: 240-687-4654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001207430
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024173346
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: