Healthcare Provider Details

I. General information

NPI: 1225147341
Provider Name (Legal Business Name): SEGUNDA YANEZ ACOSTA PH.D., A.P.R.N.,B.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10529 CRESTWOOD DR. SUITE 101
MANASSAS VA
20109-4418
US

IV. Provider business mailing address

601 JEFFERSON DAVIS HWY SUITE 101
FREDERICKSBURG VA
22401-4436
US

V. Phone/Fax

Practice location:
  • Phone: 703-392-6420
  • Fax: 703-392-6421
Mailing address:
  • Phone: 540-373-6420
  • Fax: 540-373-9026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number0015000200
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: