Healthcare Provider Details

I. General information

NPI: 1336134675
Provider Name (Legal Business Name): TONI LYNN NELSON CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 11/27/2023
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11800 SUNRISE VALLEY DR SUITE 700
RESTON VA
20191-5300
US

IV. Provider business mailing address

12011 LEE JACKSON MEMORIAL HWY SUITE 504
FAIRFAX VA
22033-3310
US

V. Phone/Fax

Practice location:
  • Phone: 703-834-1473
  • Fax: 703-318-7463
Mailing address:
  • Phone: 703-391-2030
  • Fax: 703-273-3943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024138096
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: