Provider Demographics
NPI:1417407602
Name:FRANGIPANE, EDEN ROSE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:EDEN
Middle Name:ROSE
Last Name:FRANGIPANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:481 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2071
Mailing Address - Country:US
Mailing Address - Phone:757-376-0350
Mailing Address - Fax:
Practice Address - Street 1:481 CARDINAL LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-2071
Practice Address - Country:US
Practice Address - Phone:757-376-0350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-005548363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical