Provider Demographics
NPI:1942538293
Name:LETTLEY, THEA BLUNT (FNP)
Entity Type:Individual
Prefix:
First Name:THEA
Middle Name:BLUNT
Last Name:LETTLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 RIDGE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-1861
Mailing Address - Country:US
Mailing Address - Phone:757-739-3567
Mailing Address - Fax:
Practice Address - Street 1:55 E TYLER ST
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-5402
Practice Address - Country:US
Practice Address - Phone:757-727-5315
Practice Address - Fax:757-728-6612
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024078203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily