Healthcare Provider Details

I. General information

NPI: 1861917627
Provider Name (Legal Business Name): CHRISTINE ELIZABETH JULIANA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2017
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

394 GARRISONVILLE RD STE 103
STAFFORD VA
22554-1529
US

IV. Provider business mailing address

394 GARRISONVILLE RD STE 103
STAFFORD VA
22554-1529
US

V. Phone/Fax

Practice location:
  • Phone: 540-374-5599
  • Fax: 540-735-8097
Mailing address:
  • Phone: 540-374-5599
  • Fax: 540-735-8097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005868
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110005868
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: