Healthcare Provider Details

I. General information

NPI: 1225676174
Provider Name (Legal Business Name): JORDAN ELIZABETH PACILLA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 WARRIOR DR
STEPHENS CITY VA
22655-4044
US

IV. Provider business mailing address

160 WARRIOR DR
STEPHENS CITY VA
22655-4044
US

V. Phone/Fax

Practice location:
  • Phone: 540-868-4100
  • Fax: 540-868-0888
Mailing address:
  • Phone: 540-868-4100
  • Fax: 540-868-0888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178494
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: