MEDICARE: ANJA JOY FRAZIER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0024187722	VA
2	363LF0000X	Family Nurse Practitioner	0024187722	VA
3	163W00000X	Registered Nurse	0001302152	VA

General Provider Information

NPI Number	:	1063196582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANJA JOY FRAZIER

Provider Business Mailing Address
First Line	:	1200 EDWARDS FERRY RD NE
Second Line	:
City	:	LEESBURG
State	:	VA
Zip	:	20176-3318
Country	:	US
Telephone Number	:	703-777-8059
Fax Number	:

Provider Business Practice Location Address
First Line	:	8078 CRESCENT PARK DR STE 201
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3449
Country	:	US
Telephone Number	:	703-753-4999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	04/01/2024

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