Healthcare Provider Details

I. General information

NPI: 1225674179
Provider Name (Legal Business Name): ANTONIO SEYMOUR HAMLETTE FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ANTONIO S HAMLETTE FNP

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/07/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7515 WILLIAMSON RD
HOLLINS VA
24019-4301
US

IV. Provider business mailing address

7515 WILLIAMSON RD
HOLLINS VA
24019-4301
US

V. Phone/Fax

Practice location:
  • Phone: 540-563-1010
  • Fax:
Mailing address:
  • Phone: 434-941-9459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001245996
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178402
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: