Healthcare Provider Details

I. General information

NPI: 1306466834
Provider Name (Legal Business Name): TAMI DOUGLASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR # 10968
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR # 10968
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 804-664-4157
  • Fax:
Mailing address:
  • Phone: 804-664-4157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002108886
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: