Healthcare Provider Details

I. General information

NPI: 1164055372
Provider Name (Legal Business Name): MARCIA A MELQUIST FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2020
Last Update Date: 05/30/2020
Certification Date: 05/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5041 CORPORATE WOODS DR STE 200
VIRGINIA BEACH VA
23462-4375
US

IV. Provider business mailing address

5041 CORPORATE WOODS DR STE 200
VIRGINIA BEACH VA
23462-4375
US

V. Phone/Fax

Practice location:
  • Phone: 757-490-9323
  • Fax:
Mailing address:
  • Phone: 757-567-3992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number0001234004
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number0001234004
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178793
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: