Provider Demographics
NPI:1154321636
Name:BRESLIN, JANET L (CFNP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:BRESLIN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:703-368-3161
Mailing Address - Fax:703-368-2498
Practice Address - Street 1:8640 SUDLEY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4420
Practice Address - Country:US
Practice Address - Phone:703-368-3161
Practice Address - Fax:703-368-2498
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017000821363LF0000X
VA0024066384363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1154321636Medicaid
P31238Medicare UPIN
VAVAA113525Medicare PIN
500000799Medicare ID - Type Unspecified