MEDICARE: JAIMIE SARCON TAHIR NP

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	2014017971	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	VVL477A	OTHER	VA	MEDICARE ID

General Provider Information

NPI Number	:	1528420544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIMIE SARCON TAHIR NP

Provider Business Mailing Address
First Line	:	9600 SPRING GLEN DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-8829
Country	:	US
Telephone Number	:	804-312-4044
Fax Number	:	804-454-2066

Provider Business Practice Location Address
First Line	:	9600 SPRING GLEN DR
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-8829
Country	:	US
Telephone Number	:	804-312-4044
Fax Number	:	804-454-2066

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

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	03/27/2026

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