Individual
AMANDA LEE THACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
19450 DEERFIELD AVENUE, SUITE 200, LEESBURG, VA 20176-6821
(703) 844-8380
(703) 263-8393
Mailing address
224-D CORNWALL ST., NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024185322
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114621810
—
VA
05
—
30017651500001
—
VA
Enumeration date
03/28/2023
Last updated
03/06/2024
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