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General NPI Number Information
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NPI Number | 1801825120
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Entity Type | Individual
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Provider Name | SIDENIA SURRATT TRIBBLE ACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 03/13/2013
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Provider Practice Location Address
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Address Line | 70 MEDICAL CENTER DRIVE SUITE 302
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City | FISHERSVILLE
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State | VA
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Zip | 22939
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Country | US
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Telephone | 540-221-7058
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Fax |
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Provider Business Mailing Address
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Address Line | 810 BRALEY POND RD
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City | WEST AUGUSTA
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State | VA
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Zip | 24485-2007
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Country | US
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Telephone | 540-337-6330
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 0024164211
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License Number State | VA
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