Provider Demographics
NPI:1548338973
Name:PHILLIPS, ABIGAIL ATIENZA (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:ATIENZA
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POTOMAC CENTER OFFICE
Mailing Address - Street 2:2296 OPITZ BLVD., STE. 300
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191
Mailing Address - Country:US
Mailing Address - Phone:703-523-0998
Mailing Address - Fax:
Practice Address - Street 1:POTOMAC CENTER OFFICE
Practice Address - Street 2:2296 OPITZ BLVD., STE. 300
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3354
Practice Address - Country:US
Practice Address - Phone:703-523-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024151095363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
009255K32Medicare ID - Type Unspecified
S71388Medicare UPIN