Healthcare Provider Details

I. General information

NPI: 1093411209
Provider Name (Legal Business Name): COREY ROBERT FRASCA SRNA, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E MARSHALL ST
RICHMOND VA
23298-5026
US

IV. Provider business mailing address

468 PINE TREE POINT DR
HEATHSVILLE VA
22473-2608
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-7929
  • Fax:
Mailing address:
  • Phone: 804-405-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001284981
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024192702
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: