Provider Demographics
NPI:1326161134
Name:CORCORAN, JUDY GENTRY (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:JUDY
Middle Name:GENTRY
Last Name:CORCORAN
Suffix:
Gender:F
Credentials:CFNP
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Mailing Address - Street 1:9430 FORESTWOOD LANE
Mailing Address - Street 2:#100
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110
Mailing Address - Country:US
Mailing Address - Phone:703-365-0227
Mailing Address - Fax:703-365-0332
Practice Address - Street 1:9430 FORESTWOOD LANE
Practice Address - Street 2:#100
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110
Practice Address - Country:US
Practice Address - Phone:703-365-0227
Practice Address - Fax:703-365-0332
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2016-07-27
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Provider Licenses
StateLicense IDTaxonomies
VA0024164084363LF0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1326161134Medicaid