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General NPI Number Information
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NPI Number | 1497472856
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Entity Type | Individual
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Provider Name | DEANNA HERCIK PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/25/2022
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 12872 HARBOR DR
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2921
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Country | US
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Telephone | 910-705-8588
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Fax | 910-778-1196
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Provider Business Mailing Address
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Address Line | 1604 HILLTOP WEST CTR STE 215
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City | VIRGINIA BEACH
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State | VA
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Zip | 23451-6196
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Country | US
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Telephone | 757-664-9700
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024185628
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License Number State | VA
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