Healthcare Provider Details

I. General information

NPI: 1881042000
Provider Name (Legal Business Name): SCHADAQ TORRES NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2016
Last Update Date: 03/17/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 CATLIN AVE
QUANTICO VA
22134-5109
US

IV. Provider business mailing address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4712
US

V. Phone/Fax

Practice location:
  • Phone: 973-932-9362
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number26NR12199700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ00832300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: