Provider Demographics
NPI:1043763410
Name:TATE, AMBER NICOLE (MS, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:TATE
Suffix:
Gender:F
Credentials:MS, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15521 MIDLOTHIAN TPKE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-7312
Mailing Address - Country:US
Mailing Address - Phone:804-423-1550
Mailing Address - Fax:
Practice Address - Street 1:15521 MIDLOTHIAN TPKE
Practice Address - Street 2:SUITE 105
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-7312
Practice Address - Country:US
Practice Address - Phone:804-423-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-02
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173791363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health