Healthcare Provider Details

I. General information

NPI: 1841546819
Provider Name (Legal Business Name): PATINA R GILLESPIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

263 MCLAWS CIR STE 105
WILLIAMSBURG VA
23185-5674
US

IV. Provider business mailing address

PO BOX 639295 DEPT 93303
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 757-941-5600
  • Fax:
Mailing address:
  • Phone: 757-941-5600
  • Fax: 855-618-6655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0017144717
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5007162
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024175902
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: