Provider Demographics
NPI:1336665678
Name:PHILLIPS, VIRGINIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:HOFMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11279 PERRY HWY STE 450
Mailing Address - Street 2:
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-9303
Mailing Address - Country:US
Mailing Address - Phone:724-933-1100
Mailing Address - Fax:724-933-1160
Practice Address - Street 1:6000 BROOKTREE RD STE 207
Practice Address - Street 2:
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-9279
Practice Address - Country:US
Practice Address - Phone:724-933-9110
Practice Address - Fax:724-933-9111
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY736746-1363LF0000X
PASP018054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily