Provider Demographics
NPI:1780658740
Name:ROLLINS, VIRGINIA ROBERTSON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ROBERTSON
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:VIRGINIA
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:5335 S 3400 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-9282
Mailing Address - Country:US
Mailing Address - Phone:801-791-6750
Mailing Address - Fax:801-662-4707
Practice Address - Street 1:100 MARIO CAPECCHI DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84113-1103
Practice Address - Country:US
Practice Address - Phone:801-662-4700
Practice Address - Fax:801-662-4707
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN077478 NP363L00000X
UT6823884-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000576529DMedicaid
GAS69038Medicare UPIN