MEDICARE: TIERRA LATRICE WIGGINS APRN

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	0024180432	VA
2	363L00000X	Nurse Practitioner	0024180432	VA

General Provider Information

NPI Number	:	1619572153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIERRA LATRICE WIGGINS APRN

Provider Business Mailing Address
First Line	:	NAVAL MEDICAL CENTER PORTSMOUTH
Second Line	:	620 JOHN PAUL JONES CIRCLE
City	:	PORTSMOUTH
State	:	VA
Zip	:	23708
Country	:	US
Telephone Number	:	757-953-5397
Fax Number	:

Provider Business Practice Location Address
First Line	:	5589 GREENWICH RD STE 100
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6565
Country	:	US
Telephone Number	:	888-628-8272
Fax Number	:

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

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	12/16/2025

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