Provider Demographics
NPI:1285937466
Name:TATE, JANELLE L (NP)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:L
Last Name:TATE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:L
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1413 RAND CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6461
Mailing Address - Country:US
Mailing Address - Phone:757-282-3816
Mailing Address - Fax:
Practice Address - Street 1:515 NEWTOWN RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5620
Practice Address - Country:US
Practice Address - Phone:757-499-7526
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2010-12-10
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024140083363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1285937466Medicaid
VA540896390OtherTRICARE
VA1285937466Medicare PIN