Healthcare Provider Details

I. General information

NPI: 1225751860
Provider Name (Legal Business Name): AMELIA RAE FITTS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 BULIFANTS BLVD
WILLIAMSBURG VA
23188-5747
US

IV. Provider business mailing address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

V. Phone/Fax

Practice location:
  • Phone: 757-564-7337
  • Fax: 757-564-3205
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189879
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: