Healthcare Provider Details

I. General information

NPI: 1497619100
Provider Name (Legal Business Name): VIRTRESE BALLARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 DUQUESNE PL
VIRGINIA BEACH VA
23464-4433
US

IV. Provider business mailing address

6416 DUQUESNE PL
VIRGINIA BEACH VA
23464-4433
US

V. Phone/Fax

Practice location:
  • Phone: 516-749-4090
  • Fax:
Mailing address:
  • Phone: 516-749-4090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001275286
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: