Healthcare Provider Details

I. General information

NPI: 1033719471
Provider Name (Legal Business Name): CHAD S FORRESTER MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MT CLEMENT PARK STE C
TAPPAHANNOCK VA
22560-5098
US

IV. Provider business mailing address

856 J CLYDE MORRIS BLVD STE A
NEWPORT NEWS VA
23601-1318
US

V. Phone/Fax

Practice location:
  • Phone: 804-443-6063
  • Fax: 804-443-6005
Mailing address:
  • Phone: 757-316-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024180132
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: