Provider Demographics
NPI:1881037489
Name:PUTNAM, TALYNA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:TALYNA
Middle Name:
Last Name:PUTNAM
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BROAD ROCK BOULEVARD
Mailing Address - Street 2:ROOM 5B-166
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23249
Mailing Address - Country:US
Mailing Address - Phone:804-675-5000
Mailing Address - Fax:804-675-5816
Practice Address - Street 1:1201 BROAD ROCK BOULEVARD
Practice Address - Street 2:ROOM 5B-166
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249
Practice Address - Country:US
Practice Address - Phone:804-675-5000
Practice Address - Fax:804-675-5816
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170801363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care