Healthcare Provider Details

I. General information

NPI: 1275830945
Provider Name (Legal Business Name): TAMARA LEVIN MORGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 02/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850A TOWN CENTER PKWY
RESTON VA
20190-5851
US

IV. Provider business mailing address

11275 BEACH MILL RD
GREAT FALLS VA
22066-3029
US

V. Phone/Fax

Practice location:
  • Phone: 703-437-5532
  • Fax: 703-437-0645
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168976
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: