MEDICARE: VIRGINIA ANN O PHILLIPS 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	APRN11021176	FL

General Provider Information

NPI Number	:	1659099380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA ANN O PHILLIPS APRN

Provider Business Mailing Address
First Line	:	334 SW TAYLOR GLN
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32024-0952
Country	:	US
Telephone Number	:	386-719-6843
Fax Number	:

Provider Business Practice Location Address
First Line	:	4251 NW AMERICAN LN STE 101
Second Line	:
City	:	LAKE CITY
State	:	FL
Zip	:	32055-8845
Country	:	US
Telephone Number	:	386-758-6143
Fax Number	:

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

Provider Enumeration Date	:	08/18/2022
Last Update Date	:	09/26/2023

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