Healthcare Provider Details

I. General information

NPI: 1659193183
Provider Name (Legal Business Name): MARIANA HERRERA ACNPC-AG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2024
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4020 BONNEY RD STE 105
VIRGINIA BEACH VA
23452-1765
US

IV. Provider business mailing address

4020 BONNEY RD STE 105
VIRGINIA BEACH VA
23452-1765
US

V. Phone/Fax

Practice location:
  • Phone: 434-849-4295
  • Fax:
Mailing address:
  • Phone: 434-849-4295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License Number0024191600
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024191600
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: