Healthcare Provider Details

I. General information

NPI: 1861475204
Provider Name (Legal Business Name): NANCY A ROE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6477 COLLEGE PARK SQ STE 312
VIRGINIA BEACH VA
23464-3611
US

IV. Provider business mailing address

540 CONSERVANCY WAY APT 106
CHESAPEAKE VA
23323-1334
US

V. Phone/Fax

Practice location:
  • Phone: 757-452-6932
  • Fax: 757-905-4316
Mailing address:
  • Phone: 669-411-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number453123
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberA03703
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: