MEDICARE: MICAELA IRVIN FNP-C

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	363LF0000X	Family Nurse Practitioner	F07240043	MD

General Provider Information

NPI Number	:	1538944988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICAELA IRVIN FNP-C

Provider Business Mailing Address
First Line	:	4324 2ND RD N APT 2
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-2915
Country	:	US
Telephone Number	:	301-351-6830
Fax Number	:

Provider Business Practice Location Address
First Line	:	4228 KING ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1507
Country	:	US
Telephone Number	:	301-351-6830
Fax Number	:

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

Provider Enumeration Date	:	08/25/2023
Last Update Date	:	08/30/2024

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