Provider Demographics
NPI:1538316500
Name:WASHINGTON, TIA L (RNC, WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TIA
Middle Name:L
Last Name:WASHINGTON
Suffix:
Gender:F
Credentials:RNC, WHNP-BC
Other - Prefix:
Other - First Name:TIA
Other - Middle Name:L
Other - Last Name:WASHINGTON-BENNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNC, WHNP-BC
Mailing Address - Street 1:77 NEALY AVE
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23665-2040
Mailing Address - Country:US
Mailing Address - Phone:757-225-7630
Mailing Address - Fax:
Practice Address - Street 1:77 NEALY AVE
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23665-2040
Practice Address - Country:US
Practice Address - Phone:757-225-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-21
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001157255363LW0102X
VA0024166158363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
12000325OtherCAQH