Healthcare Provider Details

I. General information

NPI: 1457629057
Provider Name (Legal Business Name): ANDREA G PERLMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 ROLLING RD STE IANDJ
SPRINGFIELD VA
22152-2307
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 571-665-6460
  • Fax: 571-665-6561
Mailing address:
  • Phone: 571-423-5741
  • Fax: 571-423-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: