Healthcare Provider Details

I. General information

NPI: 1902348121
Provider Name (Legal Business Name): VANESSA PATEL AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 10/28/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 GASKINS RD SUITE 230
RICHMOND VA
23233-4946
US

IV. Provider business mailing address

3850 GASKINS RD SUITE 230
RICHMOND VA
23233-2918
US

V. Phone/Fax

Practice location:
  • Phone: 804-543-1175
  • Fax:
Mailing address:
  • Phone: 804-543-1175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024174219
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024174219
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: