Provider Demographics
NPI:1225382492
Name:PETRAGLIA, GENEVIEVE (NP)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:PETRAGLIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44055 RIVERSIDE PKWY STE 150
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-5176
Mailing Address - Country:US
Mailing Address - Phone:703-858-6399
Mailing Address - Fax:703-858-6305
Practice Address - Street 1:44055 RIVERSIDE PKWY STE 150
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5176
Practice Address - Country:US
Practice Address - Phone:703-858-6399
Practice Address - Fax:703-858-6305
Is Sole Proprietor?:No
Enumeration Date:2012-11-08
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP500002180363LF0000X
VA0024170444363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily