Provider Demographics
NPI:1306335112
Name:CONVENIENT VIRTUCARE
Entity type:Organization
Organization Name:CONVENIENT VIRTUCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:D-ANN
Authorized Official - Middle Name:WELLER
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:240-299-5308
Mailing Address - Street 1:4340 ANTIETAM CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-1200
Mailing Address - Country:US
Mailing Address - Phone:240-299-5308
Mailing Address - Fax:
Practice Address - Street 1:4340 ANTIETAM CREEK TRL
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-1200
Practice Address - Country:US
Practice Address - Phone:240-299-5308
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-07
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QU0200X
FLARNP9371233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty