Healthcare Provider Details

I. General information

NPI: 1326968017
Provider Name (Legal Business Name): ASHCRAFT HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12005 SUNRISE VALLEY DR STE 203
RESTON VA
20191-3469
US

IV. Provider business mailing address

12005 SUNRISE VALLEY DR STE 203
RESTON VA
20191-3469
US

V. Phone/Fax

Practice location:
  • Phone: 571-250-8972
  • Fax: 571-250-8972
Mailing address:
  • Phone: 571-250-8972
  • Fax: 571-250-8972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GLENN ASHCRAFT
Title or Position: OWNER
Credential:
Phone: 817-798-9116