Provider Demographics
NPI:1447245733
Name:ABRENICA, EVA C (CRNA)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:C
Last Name:ABRENICA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3998 FAIR RIDGE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2921
Mailing Address - Country:US
Mailing Address - Phone:703-295-9360
Mailing Address - Fax:703-766-9725
Practice Address - Street 1:3600 JOSEPH SIEWICK DRIVE
Practice Address - Street 2:FAIR OAKS HOSPITAL
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033
Practice Address - Country:US
Practice Address - Phone:703-295-9360
Practice Address - Fax:703-295-9369
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8789367500000X
VA0024166978367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
261966OtherANTHEM BCBS
VA010296307Medicaid
VAP00377928OtherRAILROAD MEDICARE
VA1447245733Medicaid
430025004OtherRAILROAD MEDICARE
VA010296323Medicaid
VA139180OtherANTHEM
DCK142-0002OtherCAREFIRST
00013859OtherNHC CARE ADMINISTRATORS
VA010295807Medicaid
VA012455F81Medicare PIN
DCK142-0002OtherCAREFIRST
430025004OtherRAILROAD MEDICARE