Healthcare Provider Details

I. General information

NPI: 1932012960
Provider Name (Legal Business Name): JOBELLE TAMAYO FRIAS BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 TOWN CENTER DR STE G100
RESTON VA
20190-5897
US

IV. Provider business mailing address

12025 TOWN SQUARE ST UNIT 1403
RESTON VA
20190-6039
US

V. Phone/Fax

Practice location:
  • Phone: 703-639-3100
  • Fax:
Mailing address:
  • Phone: 757-275-2516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001314499
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: