Healthcare Provider Details

I. General information

NPI: 1619640026
Provider Name (Legal Business Name): DEANNA L CARDOSO APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

2312 INDIAN MOUND TRL
KISSIMMEE FL
34746-3634
US

V. Phone/Fax

Practice location:
  • Phone: 703-784-1725
  • Fax:
Mailing address:
  • Phone: 321-443-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11014229
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: