MEDICARE: PRISCILLA ANNE SERRANO PA

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	363A00000X	Physician Assistant	0110001354	VA

General Provider Information

NPI Number	:	1881627347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA ANNE SERRANO PA

Provider Business Mailing Address
First Line	:	5226 INDIAN RIVER RD
Second Line	:	SUITE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6179
Country	:	US
Telephone Number	:	757-216-4030
Fax Number	:	757-216-4029

Provider Business Practice Location Address
First Line	:	5226 INDIAN RIVER RD
Second Line	:	SUITE 102
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-6179
Country	:	US
Telephone Number	:	757-216-4030
Fax Number	:	757-216-4029

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/13/2012

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