Provider Demographics
NPI:1144511957
Name:TIERNEY, RENEE ELAINE (NP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:ELAINE
Last Name:TIERNEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 FRANKLIN FARMS DR RM 130
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-5100
Mailing Address - Country:US
Mailing Address - Phone:804-288-4827
Mailing Address - Fax:804-288-4494
Practice Address - Street 1:7611 FOREST AVE STE 100A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4946
Practice Address - Country:US
Practice Address - Phone:804-288-4827
Practice Address - Fax:804-288-4494
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169517363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06778OtherGROUP PTAN