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General NPI Number Information
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NPI Number | 1033796065
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Entity Type | Individual
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Provider Name | CARLA TATE FNP
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Gender | Female
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Dates
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Enumeration Date | 03/25/2021
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 8315 LEE HWY STE 202
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City | FAIRFAX
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State | VA
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Zip | 22031-2215
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Country | US
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Telephone | 703-798-2695
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Fax |
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Provider Business Mailing Address
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Address Line | 6151 TAFFY CT
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4182
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Country | US
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Telephone | 703-798-2695
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024181100
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License Number State | VA
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