Provider Demographics
NPI:1730756263
Name:EDGE, ERICA NICOLE (NP)
Entity type:Individual
Prefix:DR
First Name:ERICA
Middle Name:NICOLE
Last Name:EDGE
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 1:8109 HINSON FARM RD #504
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306
Mailing Address - Country:US
Mailing Address - Phone:703-780-2800
Mailing Address - Fax:703-780-0461
Practice Address - Street 1:8109 HINSON FARM RD #504
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306
Practice Address - Country:US
Practice Address - Phone:703-780-2000
Practice Address - Fax:703-780-0461
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily