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General NPI Number Information
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NPI Number | 1770304073
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Entity Type | Organization
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Legal Business Name | COLONIAL AESTHETICS & WELLNESS
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 1313 JAMESTOWN RD STE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-3362
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Country | US
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Telephone | 757-585-4162
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 JAMESTOWN RD STE 101
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-3362
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Country | US
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Telephone | 757-585-4162
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Fax |
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Authorized Official
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Title or Position | FNP/OWNER
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Name | BRITTANY STROUD PTACHICK
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Credential | FNP
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Telephone | 757-532-3563
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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 |
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License Number State |
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