Provider Demographics
NPI:1346683182
Name:BOHATEC, BRENNA B (FNP)
Entity Type:Individual
Prefix:
First Name:BRENNA
Middle Name:B
Last Name:BOHATEC
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Gender:F
Credentials:FNP
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Mailing Address - Street 1:7202 GLEN FOREST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3781
Mailing Address - Country:US
Mailing Address - Phone:804-676-2024
Mailing Address - Fax:804-673-1796
Practice Address - Street 1:210 MEDICAL PARK BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9338
Practice Address - Country:US
Practice Address - Phone:804-431-1100
Practice Address - Fax:804-862-1094
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2016-09-15
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Provider Licenses
StateLicense IDTaxonomies
VA0024170794363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV9536DMedicare PIN