Individual
STACIA D PETRANCOSTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
500 W ANNANDALE RD, FALLS CHURCH, VA 22046
(703) 521-6662
Mailing address
9555 PINE CLUSTER CIR, VIENNA, VA 22181-5440
(910) 578-7053
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
03/05/2010
Last updated
08/22/2018
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