Healthcare Provider Details

I. General information

NPI: 1790506442
Provider Name (Legal Business Name): BLACK HIBISCUS INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4663 HAYGOOD RD STE 203
VIRGINIA BEACH VA
23455-5442
US

IV. Provider business mailing address

6470 CRESCENT WAY APT 301
NORFOLK VA
23513-1434
US

V. Phone/Fax

Practice location:
  • Phone: 757-917-8841
  • Fax:
Mailing address:
  • Phone: 347-926-3188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: VERNICA ANDERSON
Title or Position: OWNER
Credential: NP
Phone: 347-926-3188