Provider Demographics
NPI:1497472856
Name:HERCIK, DEANNA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:HERCIK
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1604 HILLTOP WEST CTR STE 215
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6196
Mailing Address - Country:US
Mailing Address - Phone:757-664-9700
Mailing Address - Fax:
Practice Address - Street 1:12872 HARBOR DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2921
Practice Address - Country:US
Practice Address - Phone:910-705-8588
Practice Address - Fax:910-778-1196
Is Sole Proprietor?:No
Enumeration Date:2022-10-25
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024185628363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health