Provider Demographics
NPI:1083489785
Name:IFARRAGUERRI, ELENA SOPHIA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:SOPHIA
Last Name:IFARRAGUERRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1749 OLD MEADOW RD STE 600
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4323
Mailing Address - Country:US
Mailing Address - Phone:703-783-3300
Mailing Address - Fax:703-783-3300
Practice Address - Street 1:1749 OLD MEADOW RD STE 600
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4323
Practice Address - Country:US
Practice Address - Phone:703-783-3300
Practice Address - Fax:703-783-3300
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP500014541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily