Provider Demographics
NPI:1962941013
Name:CAROZZA, BREANNA (NP)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:CAROZZA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4226 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1507
Mailing Address - Country:US
Mailing Address - Phone:571-777-8938
Mailing Address - Fax:
Practice Address - Street 1:4226 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1507
Practice Address - Country:US
Practice Address - Phone:571-777-8938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180880363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health