Provider Demographics
NPI:1639541071
Name:GORACKE, VIRGINIA ANNE (APRN)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANNE
Last Name:GORACKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:VIRGINIA
Other - Middle Name:ANNE
Other - Last Name:ARCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, WHNP-BC
Mailing Address - Street 1:2301 ERWIN RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-4699
Mailing Address - Country:US
Mailing Address - Phone:919-684-8111
Mailing Address - Fax:
Practice Address - Street 1:2301 ERWIN RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-4699
Practice Address - Country:US
Practice Address - Phone:919-684-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173595363LW0102X
SC19245363LW0102X
NC5014351363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health