Provider Demographics
NPI:1598446031
Name:HAMLIN-ENRIQUEZ, GRAYCE ELMA (FNP)
Entity Type:Individual
Prefix:
First Name:GRAYCE
Middle Name:ELMA
Last Name:HAMLIN-ENRIQUEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 EISENHOWER AVE APT 602
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-6901
Mailing Address - Country:US
Mailing Address - Phone:507-951-3945
Mailing Address - Fax:
Practice Address - Street 1:8988 LORTON STATION BLVD STE 201
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4758
Practice Address - Country:US
Practice Address - Phone:703-339-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024187651363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty