| Amanda Lee Thacker, FNP | |
|
19450 Deerfield Avenue, Suite 200, Leesburg, VA 20176-6821 | |
| (703) 844-8380 | |
| (703) 263-8393 |
| Full Name | Amanda Lee Thacker |
|---|---|
| Gender | Female |
| Speciality | Nurse Practitioner - Family |
| Location | 19450 Deerfield Avenue, Suite 200, Leesburg, Virginia |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114621810 | NPI | - | NPPES |
| 30017651500001 | Medicaid | VA | |
| 1114621810 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 0024185322 (Virginia) | Primary |
| Entity Name | Loudoun Medical Group, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1679591440 PECOS PAC ID: 0042119661 Enrollment ID: O20041115000474 |
| Mailing Address | Practice Location Address |
|---|---|
| Amanda Lee Thacker, FNP 224-d Cornwall St., Nw, Suite 403, Leesburg, VA 20176-2704 Ph: (703) 737-6010 | Amanda Lee Thacker, FNP 19450 Deerfield Avenue, Suite 200, Leesburg, VA 20176-6821 Ph: (703) 844-8380 |
Carol Gavin, PMHNP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 19 Fort Evans Rd Ne Ste C, Leesburg, VA 20176 Phone: 703-737-2110 Fax: 703-737-2111 | |
Gillian Zeile, Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 44035 Riverside Pkwy, Suite 300, Leesburg, VA 20176 Phone: 703-554-6800 | |
Mrs. Megan Franklin Pirowski, RN, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 44055 Riverside Pkwy, Leesburg, VA 20176 Phone: 703-858-8878 | |
Mrs. Adrianne J Gruner, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 163 Fort Evans Rd Ne, Leesburg, VA 20176 Phone: 703-443-2000 | |
Alice R Spiros, NURSE PRACTITIONER Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 44035 Riverside Pkwy Ste 300, Leesburg, VA 20176 Phone: 703-554-6800 Fax: 703-724-7503 | |
Darren John Hunt, RN, MSN, ACNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 44045 Riverside Pkwy Ste 100, Leesburg, VA 20176 Phone: 703-858-8878 Fax: 703-858-8170 | |
Mrs. Catherine Marie Staats, N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 44045 Riverside Pkwy, Leesburg, VA 20176 Phone: 703-858-8878 Fax: 703-858-8701 |