Healthcare Provider Details

I. General information

NPI: 1659121903
Provider Name (Legal Business Name): APRIL MARIE GUSTILO HORTILLOSA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2024
Last Update Date: 05/13/2024
Certification Date: 05/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6317 W WASHINGTON ST.
PETERSBURG VA
23803
US

IV. Provider business mailing address

6317 W WASHINGTON ST.
PETERSBURG VA
23801
US

V. Phone/Fax

Practice location:
  • Phone: 804-524-4416
  • Fax:
Mailing address:
  • Phone: 804-524-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024190182
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001284384
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: