Provider Demographics
NPI:1164055372
Name:MELQUIST, MARCIA A (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:A
Last Name:MELQUIST
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5041 CORPORATE WOODS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4375
Mailing Address - Country:US
Mailing Address - Phone:757-567-3992
Mailing Address - Fax:
Practice Address - Street 1:5041 CORPORATE WOODS DR STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4375
Practice Address - Country:US
Practice Address - Phone:757-490-9323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2020-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001234004163WP0808X, 163WH1000X
VA0024178793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163WH1000XNursing Service ProvidersRegistered NurseHospice