Healthcare Provider Details

I. General information

NPI: 1992646343
Provider Name (Legal Business Name): MARISSA VICTORIA MITROVIC FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W LEE HWY
WARRENTON VA
20186-2149
US

IV. Provider business mailing address

13123 CROSS KEYS CT
FAIRFAX VA
22033-1426
US

V. Phone/Fax

Practice location:
  • Phone: 540-351-0662
  • Fax:
Mailing address:
  • Phone: 757-869-8223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024196116
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: