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General NPI Number Information
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NPI Number | 1942766035
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Entity Type | Individual
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Provider Name | GRACE VICTORIA SPINKS PA-C
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Gender | Female
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 07/03/2020
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Provider Practice Location Address
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Address Line | 110 IRVING ST NW # 4B42
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City | WASHINGTON
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State | DC
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Zip | 20010-3017
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Country | US
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Telephone | 214-914-6696
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Fax |
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Provider Business Mailing Address
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Address Line | 13060 ELM TREE DR APT 401
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City | HERNDON
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State | VA
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Zip | 20171-4871
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Country | US
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Telephone | 214-914-6696
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA031739
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License Number State | DC
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