MEDICARE: LINA COLLELI 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	0024189834	VA

General Provider Information

NPI Number	:	1568213247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINA COLLELI FNP-C

Provider Business Mailing Address
First Line	:	9402 WOODED GLEN AVE
Second Line	:
City	:	BURKE
State	:	VA
Zip	:	22015-4230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 WILSON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-4417
Country	:	US
Telephone Number	:	571-310-3223
Fax Number	:

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

Provider Enumeration Date	:	03/29/2024
Last Update Date	:	03/29/2024

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