Provider Demographics
NPI:1366292112
Name:TESFAYE, SERKALMAZ (FNP-BC)
Entity type:Individual
Prefix:
First Name:SERKALMAZ
Middle Name:
Last Name:TESFAYE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 MEADOW GLADE LN
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5614
Mailing Address - Country:US
Mailing Address - Phone:703-989-3607
Mailing Address - Fax:
Practice Address - Street 1:6320 MEADOW GLADE LN
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5614
Practice Address - Country:US
Practice Address - Phone:703-989-3607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189110364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health