Provider Demographics
NPI:1518405802
Name:BHAVSAR, DHARIKA M (FNP - C)
Entity Type:Individual
Prefix:
First Name:DHARIKA
Middle Name:M
Last Name:BHAVSAR
Suffix:
Gender:F
Credentials:FNP - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12207 DESOTO FALLS CT
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-2172
Mailing Address - Country:US
Mailing Address - Phone:703-853-2955
Mailing Address - Fax:
Practice Address - Street 1:3914 CENTREVILLE RD STE 250
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3290
Practice Address - Country:US
Practice Address - Phone:703-435-1223
Practice Address - Fax:703-435-1868
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2021-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174359363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner