Provider Demographics
NPI:1588277008
Name:TEBBENHOFF, BILLINDA (NP)
Entity type:Individual
Prefix:
First Name:BILLINDA
Middle Name:
Last Name:TEBBENHOFF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20329 ADVANTAGE CT
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3853
Mailing Address - Country:US
Mailing Address - Phone:703-395-2936
Mailing Address - Fax:
Practice Address - Street 1:20329 ADVANTAGE CT
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3853
Practice Address - Country:US
Practice Address - Phone:703-395-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015001088364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist