Provider Demographics
NPI:1982428728
Name:TAMAYO, SOPHIA (FNP-BC)
Entity type:Individual
Prefix:
First Name:SOPHIA
Middle Name:
Last Name:TAMAYO
Suffix:
Gender:
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 1:207 KINGS HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2693
Mailing Address - Country:US
Mailing Address - Phone:540-216-2183
Mailing Address - Fax:888-375-1486
Practice Address - Street 1:207 KINGS HWY
Practice Address - Street 2:STE 103
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22405-2693
Practice Address - Country:US
Practice Address - Phone:540-216-2183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-08
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191747363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily