Healthcare Provider Details

I. General information

NPI: 1205956471
Provider Name (Legal Business Name): JANIE VILLARIN NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 TOWN CENTER DRIVE, SUITE 309
RESTON VA
20190-3292
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW. SUITE 403
LEESBURG VA
20176-3292
US

V. Phone/Fax

Practice location:
  • Phone: 703-437-0001
  • Fax: 703-787-5739
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166539
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: