Provider Demographics
NPI:1730782319
Name:COCA, GEORGINA (PMHNP)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:COCA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17600 BARRON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:DUMFRIES
Mailing Address - State:VA
Mailing Address - Zip Code:22025-2054
Mailing Address - Country:US
Mailing Address - Phone:703-598-4115
Mailing Address - Fax:
Practice Address - Street 1:2800 EISENHOWER AVE STE 220
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-4587
Practice Address - Country:US
Practice Address - Phone:703-598-4115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186655363LP0808X, 2084P0800X
VA0001267203163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry