Carla Tate, FNP | |
8315 Lee Hwy Ste 202, Fairfax, VA 22031-2215 | |
(703) 798-2695 | |
Not Available |
Full Name | Carla Tate |
---|---|
Gender | Female |
Speciality | Nurse Practitioner - Family |
Location | 8315 Lee Hwy Ste 202, Fairfax, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1033796065 | NPI | - | NPPES |
F03210455 | Other | VA | AANP |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 0024181100 (Virginia) | Primary |
Entity Name | Prestige Medical House Call Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1497316269 PECOS PAC ID: 1658704036 Enrollment ID: O20191126002130 |
Mailing Address | Practice Location Address |
---|---|
Carla Tate, FNP 6151 Taffy Ct, Woodbridge, VA 22193-4182 Ph: (703) 798-2695 | Carla Tate, FNP 8315 Lee Hwy Ste 202, Fairfax, VA 22031-2215 Ph: (703) 798-2695 |
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