Healthcare Provider Details

I. General information

NPI: 1700448438
Provider Name (Legal Business Name): BRIANNA JOY MCHUGH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 05/24/2024
Certification Date: 05/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11803 JEFFERSON AVE STE 100
NEWPORT NEWS VA
23606-4390
US

IV. Provider business mailing address

11803 JEFFERSON AVE STE 100
NEWPORT NEWS VA
23606-4390
US

V. Phone/Fax

Practice location:
  • Phone: 757-594-1850
  • Fax: 757-594-1841
Mailing address:
  • Phone: 757-594-1850
  • Fax: 757-594-1841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110008223
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number50.006717RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: