Provider Demographics
NPI:1801027180
Name:REZA, VERONICA J (FNP)
Entity Type:Individual
Prefix:MRS
First Name:VERONICA
Middle Name:J
Last Name:REZA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:VERONICA
Other - Middle Name:J
Other - Last Name:LISENBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2620 ELM HILL PIKE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-3108
Mailing Address - Country:US
Mailing Address - Phone:615-425-4277
Mailing Address - Fax:615-891-5244
Practice Address - Street 1:14101 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6523
Practice Address - Country:US
Practice Address - Phone:804-893-5144
Practice Address - Fax:615-425-4271
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1801027180Medicaid
WI1801027180Medicaid