Provider Demographics
NPI:1912218017
Name:ACIRA HEALTH PROFESSIONAL INC
Entity Type:Organization
Organization Name:ACIRA HEALTH PROFESSIONAL INC
Other - Org Name:THE PRACTICE, SET FEE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AMEANTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:757-777-7267
Mailing Address - Street 1:3952 TARTAN TRL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-1512
Mailing Address - Country:US
Mailing Address - Phone:757-777-7267
Mailing Address - Fax:
Practice Address - Street 1:3380 PRINCESS ANNE RD
Practice Address - Street 2:STE 109C
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-2620
Practice Address - Country:US
Practice Address - Phone:757-777-7267
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166866261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center