Individual
MRS. IDA TRICE VACLAVIK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
601 WATKINS CENTRE PKWY, SUITE 200, MIDLOTHIAN, VA 23114-0002
(804) 594-3130
(804) 423-6517
Mailing address
601 WATKINS CENTRE PKWY, SUITE 200, MIDLOTHIAN, VA 23114-0002
(804) 594-3130
(804) 423-6517
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024172575
VA
363LF0000X
Family Nurse Practitioner
RN1008705
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C09633
GROUP PTAN
VA
Enumeration date
08/15/2011
Last updated
05/21/2015
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