Provider Demographics
NPI:1861475204
Name:ROE, NANCY A (NP)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:A
Last Name:ROE
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 1:540 CONSERVANCY WAY APT 106
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-1334
Mailing Address - Country:US
Mailing Address - Phone:669-411-8518
Mailing Address - Fax:
Practice Address - Street 1:6477 COLLEGE PARK SQ STE 312
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-3611
Practice Address - Country:US
Practice Address - Phone:757-452-6932
Practice Address - Fax:757-905-4316
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY453123363L00000X
VAA03703363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02671052Medicaid
NYQ21422Medicare UPIN
NYRA7472Medicare ID - Type Unspecified