Healthcare Provider Details

I. General information

NPI: 1326088477
Provider Name (Legal Business Name): PATRICIA ANN ROBERTS ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 BROAD ROCK BLVD DEPT OF CARDIOLOGY
RICHMOND VA
23249-0001
US

IV. Provider business mailing address

11600 TIMBERLY WAYE
RICHMOND VA
23238-3472
US

V. Phone/Fax

Practice location:
  • Phone: 804-675-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024165887
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: