Provider Demographics
NPI:1255648937
Name:TITCHENELL, LAURA (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:TITCHENELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43849 DELIGHTFUL PL
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-3800
Mailing Address - Country:US
Mailing Address - Phone:626-264-0002
Mailing Address - Fax:
Practice Address - Street 1:102 HERITAGE WAY NE STE 100
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4544
Practice Address - Country:US
Practice Address - Phone:703-777-0236
Practice Address - Fax:703-771-5393
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171126363LF0000X
CA704751363LF0000X
DC1032285363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily