Provider Demographics
NPI:1407201833
Name:ERMITANIO, ANN ROCHELL (PA)
Entity Type:Individual
Prefix:
First Name:ANN ROCHELL
Middle Name:
Last Name:ERMITANIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14989 GRASSY KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-6004
Mailing Address - Country:US
Mailing Address - Phone:808-829-1527
Mailing Address - Fax:
Practice Address - Street 1:8081 INNOVATION PARK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-472-4724
Practice Address - Fax:571-472-0241
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP096363A00000X
MDC0007287363A00000X
VA0110008315363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant