Provider Demographics
NPI:1184223539
Name:TIKVINA, MIRNESA (MSN, CRNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MIRNESA
Middle Name:
Last Name:TIKVINA
Suffix:
Gender:F
Credentials:MSN, CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 WASHINGTON BLVD STE F
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-2166
Mailing Address - Country:US
Mailing Address - Phone:703-827-1484
Mailing Address - Fax:
Practice Address - Street 1:3000 WASHINGTON BLVD STE F
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-2166
Practice Address - Country:US
Practice Address - Phone:703-827-1484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001283889163W00000X
VA0024185531207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine