Healthcare Provider Details

I. General information

NPI: 1457171928
Provider Name (Legal Business Name): UHURUA AMBER-FAWNN GILLESPIE FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2024
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3235 ACADEMY AVE STE 305
PORTSMOUTH VA
23703-3200
US

IV. Provider business mailing address

411 HUSTINGS LANE UNIT D
NEWPORT NEWS VA
23608
US

V. Phone/Fax

Practice location:
  • Phone: 757-686-9300
  • Fax:
Mailing address:
  • Phone: 757-814-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024191301
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: