Provider Demographics
NPI:1386115178
Name:LAZOS, HEIDI JOY (AGNP)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JOY
Last Name:LAZOS
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5516 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5629
Mailing Address - Country:US
Mailing Address - Phone:757-473-3969
Mailing Address - Fax:757-506-0157
Practice Address - Street 1:5516 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5629
Practice Address - Country:US
Practice Address - Phone:757-473-3969
Practice Address - Fax:757-506-0157
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176874363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology