Healthcare Provider Details

I. General information

NPI: 1346163276
Provider Name (Legal Business Name): SEAN M PORTER AGACNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

521 LASKIN RD APT 508
VIRGINIA BEACH VA
23451-3998
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number0024198194
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: