Provider Demographics
NPI:1013682681
Name:TESSERA, ELIA (PMHNP)
Entity Type:Individual
Prefix:
First Name:ELIA
Middle Name:
Last Name:TESSERA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5523 NEDDLETON AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4113
Mailing Address - Country:US
Mailing Address - Phone:703-989-3169
Mailing Address - Fax:
Practice Address - Street 1:5523 NEDDLETON AVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4113
Practice Address - Country:US
Practice Address - Phone:703-989-3169
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182445363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health