Healthcare Provider Details

I. General information

NPI: 1851922041
Provider Name (Legal Business Name): TERA M STANISTREET APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2020
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 LYNNHAVEN PKWY STE 400
VIRGINIA BEACH VA
23452-7332
US

IV. Provider business mailing address

1209 MOOREFIELD CT
VIRGINIA BEACH VA
23454-2210
US

V. Phone/Fax

Practice location:
  • Phone: 757-650-1762
  • Fax: 757-257-1500
Mailing address:
  • Phone: 757-650-1762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024178987
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178987
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: