Provider Demographics
NPI:1104597228
Name:GILLESPIE, DAVINA ANN (FNP)
Entity type:Individual
Prefix:
First Name:DAVINA
Middle Name:ANN
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DAVINA
Other - Middle Name:ANN
Other - Last Name:KACHNOVITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:125 EDMOND DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2619
Mailing Address - Country:US
Mailing Address - Phone:302-685-3628
Mailing Address - Fax:
Practice Address - Street 1:901 ENTERPRISE PKWY STE 900
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6250
Practice Address - Country:US
Practice Address - Phone:757-827-2480
Practice Address - Fax:757-827-2566
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily