Provider Demographics
NPI:1659099380
Name:PHILLIPS, VIRGINIA ANN O (APRN)
Entity Type:Individual
Prefix:
First Name:VIRGINIA ANN
Middle Name:O
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:334 SW TAYLOR GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-0952
Mailing Address - Country:US
Mailing Address - Phone:386-719-6843
Mailing Address - Fax:
Practice Address - Street 1:4251 NW AMERICAN LN STE 101
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-8845
Practice Address - Country:US
Practice Address - Phone:386-758-6143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11021176363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily