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General NPI Number Information
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NPI Number | 1275705196
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Entity Type | Organization
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Legal Business Name | ISLE OF WIGHT FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 04/01/2008
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Last Update Date | 04/01/2008
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Provider Practice Location Address
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Address Line | 1807 SOUTH CHURCH STREET SUITE 200 C
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City | SMITHFIELD
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State | VA
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Zip | 23430
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Country | US
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Telephone | 757-332-6342
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Fax | 757-357-9214
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Provider Business Mailing Address
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Address Line | 1807 SOUTH CHURCH STREET SUITE 200 C
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City | SMITHFIELD
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State | VA
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Zip | 23430
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Country | US
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Telephone | 757-332-6342
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Fax | 757-357-9214
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Authorized Official
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Title or Position | FAMILY NURSE PRATITIONER
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Name | CECELIA CLARKE
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Credential | FNP
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Telephone | 757-332-6342
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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 | 1023097615
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License Number State | VA
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