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Individual

MS. TANJA NUNNOLD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
P.A.

Contact information

Practice address
291 INDEPENDENCE BLVD, PEMBROKE BLDG 4 STE 522, VIRGINIA BEACH, VA 23462
(757) 490-6637
(757) 490-6636
Mailing address
291 INDEPENDENCE BLVD, PEMBROKE BLDG 4 STE 522, VIRGINIA BEACH, VA 23462
(757) 490-6637
(757) 490-6636

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002120
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01000002120
STATE LICENSE
VA
Enumeration date
08/09/2006
Last updated
06/17/2008
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