Provider Demographics
NPI:1336692524
Name:SOURBEER, AMBER LYNN (PA-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LYNN
Last Name:SOURBEER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:LYNN
Other - Last Name:ACHESINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2075 GLENN MITCHELL DR
Mailing Address - Street 2:STE 400
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-0179
Mailing Address - Country:US
Mailing Address - Phone:757-507-8900
Mailing Address - Fax:
Practice Address - Street 1:2075 GLENN MITCHELL DR
Practice Address - Street 2:STE 400
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-0179
Practice Address - Country:US
Practice Address - Phone:757-507-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005448363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical