Provider Demographics
NPI:1285240648
Name:HATCH, STEPHANIE WILLIAMS (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WILLIAMS
Last Name:HATCH
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920A BRIDGE RD STE 204
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-1117
Mailing Address - Country:US
Mailing Address - Phone:757-983-0351
Mailing Address - Fax:757-510-9218
Practice Address - Street 1:3920A BRIDGE RD STE 204
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-1117
Practice Address - Country:US
Practice Address - Phone:757-983-0351
Practice Address - Fax:757-510-9218
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180183363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care