Healthcare Provider Details

I. General information

NPI: 1356401517
Provider Name (Legal Business Name): TAMARA C HALL RN ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 HARRIS DR.
KILMARNOCK VA
22482
US

IV. Provider business mailing address

PO BOX 535
BURGESS VA
22432-0535
US

V. Phone/Fax

Practice location:
  • Phone: 804-435-2651
  • Fax:
Mailing address:
  • Phone: 804-453-7517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0024165987
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: