Provider Demographics
NPI:1841604204
Name:TAVARES-STOECKEL, CASIE LAINE (NP)
Entity Type:Individual
Prefix:MRS
First Name:CASIE
Middle Name:LAINE
Last Name:TAVARES-STOECKEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6355 WALKER LANE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310
Mailing Address - Country:US
Mailing Address - Phone:703-924-2100
Mailing Address - Fax:703-922-6067
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 401
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-924-2100
Practice Address - Fax:703-922-6067
Is Sole Proprietor?:No
Enumeration Date:2014-06-13
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily