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General NPI Number Information
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NPI Number | 1912218017
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Entity Type | Organization
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Legal Business Name | ACIRA HEALTH PROFESSIONAL INC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 3380 PRINCESS ANNE RD STE 109C
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-2620
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Country | US
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Telephone | 757-777-7267
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Fax |
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Provider Business Mailing Address
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Address Line | 3952 TARTAN TRL
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-1512
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Country | US
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Telephone | 757-777-7267
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. AMEANTHEA BLANCO
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Credential | D.N.P., FNP-C
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Telephone | 757-777-7267
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0024166866
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License Number State | VA
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