Provider Demographics
NPI:1417347451
Name:DOYLE, AUDRA LISA (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:AUDRA
Middle Name:LISA
Last Name:DOYLE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 CENTRAL PARK AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3271
Mailing Address - Country:US
Mailing Address - Phone:650-761-4737
Mailing Address - Fax:877-395-9003
Practice Address - Street 1:249 CENTRAL PARK AVE STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-3271
Practice Address - Country:US
Practice Address - Phone:650-761-4737
Practice Address - Fax:877-395-9003
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172315363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care