Healthcare Provider Details

I. General information

NPI: 1346962818
Provider Name (Legal Business Name): ERICA YAMAT HOTMIRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 OPITZ BLVD
WOODBRIDGE VA
22191-3304
US

IV. Provider business mailing address

3544 DEVON DR
FALLS CHURCH VA
22042-4028
US

V. Phone/Fax

Practice location:
  • Phone: 703-494-1144
  • Fax: 703-494-5647
Mailing address:
  • Phone: 703-439-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001234008
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024185201
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: