Provider Demographics
NPI:1629567631
Name:FLOWERS, TEGAN
Entity Type:Individual
Prefix:
First Name:TEGAN
Middle Name:
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TEGAN
Other - Middle Name:FLOWERS
Other - Last Name:COX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 N ARTHUR ASHE BLVD APT 6
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1949
Mailing Address - Country:US
Mailing Address - Phone:804-426-3414
Mailing Address - Fax:
Practice Address - Street 1:7605 FOREST AVE STE 411
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23229-4941
Practice Address - Country:US
Practice Address - Phone:804-285-8806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176100363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health