Healthcare Provider Details

I. General information

NPI: 1316209950
Provider Name (Legal Business Name): ALISHA ANN HUFFMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2012
Last Update Date: 06/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 GARRISONVILLE RD STE 211
STAFFORD VA
22554-1545
US

IV. Provider business mailing address

385 GARRISONVILLE RD STE 211
STAFFORD VA
22554-1545
US

V. Phone/Fax

Practice location:
  • Phone: 540-318-8602
  • Fax: 540-657-1220
Mailing address:
  • Phone: 540-318-8602
  • Fax: 540-657-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003828
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: