MEDICARE: VINNA PATRICIA SAN JUAN FNP-BC

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	0024191981	VA
2	363LF0000X	Family Nurse Practitioner	NP1042713	DC

General Provider Information

NPI Number	:	1841086378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINNA PATRICIA SAN JUAN FNP-BC

Provider Business Mailing Address
First Line	:	1420 BEVERLY RD STE 300
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3734
Country	:	US
Telephone Number	:	202-295-0540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1420 BEVERLY RD
Second Line	:
City	:	MC LEAN
State	:	VA
Zip	:	22101-3732
Country	:	US
Telephone Number	:	202-295-0540
Fax Number	:

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

Provider Enumeration Date	:	04/21/2025
Last Update Date	:	04/30/2025

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