Healthcare Provider Details

I. General information

NPI: 1821575879
Provider Name (Legal Business Name): BRIDGET HALEY SYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIDGET LOIS HALEY

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 12/09/2022
Certification Date: 12/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8988 LORTON STATION BLVD STE 100
LORTON VA
22079-4757
US

IV. Provider business mailing address

7764 ARMISTEAD RD STE 240
LORTON VA
22079-1920
US

V. Phone/Fax

Practice location:
  • Phone: 703-780-2800
  • Fax: 703-780-0461
Mailing address:
  • Phone: 703-780-2800
  • Fax: 703-780-0461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176362
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: