Provider Demographics
NPI:1467002097
Name:MADRIGAL, DILLON JACKSON (APRN)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:JACKSON
Last Name:MADRIGAL
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12018 SUNRISE VALLEY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3434
Mailing Address - Country:US
Mailing Address - Phone:757-666-8285
Mailing Address - Fax:844-754-8291
Practice Address - Street 1:12018 SUNRISE VALLEY DR STE 400
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3434
Practice Address - Country:US
Practice Address - Phone:757-666-8285
Practice Address - Fax:844-754-8291
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIAPRN02131363LA2200X
VA0024182996363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health