Provider Demographics
NPI:1548742133
Name:AHSAN, HENA ISLAM (MSN, NP-C)
Entity Type:Individual
Prefix:
First Name:HENA
Middle Name:ISLAM
Last Name:AHSAN
Suffix:
Gender:F
Credentials:MSN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224D CORNWALL ST NW STE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:
Practice Address - Street 1:19450 DEERFIELD AVENUE
Practice Address - Street 2:SUITE 265
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-5179
Practice Address - Country:US
Practice Address - Phone:703-858-3060
Practice Address - Fax:703-858-3061
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1548742133Medicaid
VA30015468390001Medicaid