Individual
TIA E ROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
661 UNIVERSITY LN STE A, ORANGE, VA 22960-2243
(434) 924-5400
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0024165392
VA
363LP0200X
Pediatric Nurse Practitioner
Primary
0024165392
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010301912
—
VA
Enumeration date
03/20/2007
Last updated
01/29/2024
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