Provider Demographics
NPI:1225510027
Name:CHARIPOVA, GULNARA
Entity Type:Individual
Prefix:
First Name:GULNARA
Middle Name:
Last Name:CHARIPOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GULNARA
Other - Middle Name:
Other - Last Name:CHARIPOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:20611 DUXBURY TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3251
Mailing Address - Country:US
Mailing Address - Phone:703-407-3977
Mailing Address - Fax:
Practice Address - Street 1:1850 TOWN CENTER PKWY STE 412
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3300
Practice Address - Country:US
Practice Address - Phone:703-689-9379
Practice Address - Fax:703-639-9569
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2023-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC002385207Q00000X
VA0024180533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine