Individual
MS. TATIANA NELSA VISCARRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3300 GALLOWS RD, FALLS CHURCH, VA 22042-3307
(703) 776-4001
Mailing address
3112 12TH ST S, ARLINGTON, VA 22204-4318
(703) 232-8160
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110006599
VA
363AS0400X
Surgical Physician Assistant
0110-006599
VA
Other
Enumeration date
06/11/2019
Last updated
08/21/2019
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