Individual
ASHLEY M THALACKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
44045 RIVERSIDE PKWY, LEESBURG, VA 20176-5101
(703) 858-8074
(703) 858-6797
Mailing address
19993 PRESIDENTS CUP TER, ASHBURN, VA 20147-4117
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
0024171955
VA
363LF0000X
Family Nurse Practitioner
Primary
0024171955
VA
Other
Enumeration date
09/08/2014
Last updated
06/12/2024
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