Provider Demographics
NPI:1043768682
Name:FASANELLA, ANGELA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:FASANELLA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14904 JEFFERSON DAVIS HWY STE 208
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3908
Mailing Address - Country:US
Mailing Address - Phone:703-224-9999
Mailing Address - Fax:571-384-6702
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY STE 208
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191
Practice Address - Country:US
Practice Address - Phone:703-224-9999
Practice Address - Fax:571-384-6702
Is Sole Proprietor?:No
Enumeration Date:2016-09-12
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily