Provider Demographics
NPI:1033864392
Name:FERMIL, LISA ALANE (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ALANE
Last Name:FERMIL
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3002
Mailing Address - Country:US
Mailing Address - Phone:573-952-3237
Mailing Address - Fax:757-395-6280
Practice Address - Street 1:1060 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:573-952-3237
Practice Address - Fax:757-395-6280
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183199363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care