Healthcare Provider Details

I. General information

NPI: 1285598110
Provider Name (Legal Business Name): CAROL T STAFFORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 OLD WILLIAMSBURG RD
YORKTOWN VA
23690-3910
US

IV. Provider business mailing address

292 LITTLETOWN QUARTER
WILLIAMSBURG VA
23185-5594
US

V. Phone/Fax

Practice location:
  • Phone: 757-886-0608
  • Fax: 757-369-3821
Mailing address:
  • Phone: 757-886-0608
  • Fax: 757-369-3821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001212317
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: