Provider Demographics
NPI:1144601980
Name:ALSTON, TERRINDA
Entity Type:Individual
Prefix:
First Name:TERRINDA
Middle Name:
Last Name:ALSTON
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 1:2125 SILVERBERRY DR APT 208
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-3281
Mailing Address - Country:US
Mailing Address - Phone:757-739-4577
Mailing Address - Fax:757-299-1719
Practice Address - Street 1:6330 NEWTOWN RD STE 250
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-4802
Practice Address - Country:US
Practice Address - Phone:757-739-4577
Practice Address - Fax:757-299-1719
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172512363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05149Medicare PIN