Provider Demographics
NPI:1992132310
Name:TASIE, BETTY (NP)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:TASIE
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-368-3161
Mailing Address - Fax:
Practice Address - Street 1:12701 MARBLESTONE DR
Practice Address - Street 2:SUITE 130
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-8325
Practice Address - Country:US
Practice Address - Phone:571-284-4350
Practice Address - Fax:703-580-4990
Is Sole Proprietor?:No
Enumeration Date:2013-09-30
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1025453363LF0000X
VA002417114363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily