Provider Demographics
NPI:1053894493
Name:OLLIVER, NATASHA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:
Last Name:OLLIVER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 GREENSBORO DR STE 900
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4931
Mailing Address - Country:US
Mailing Address - Phone:703-665-9613
Mailing Address - Fax:703-665-9689
Practice Address - Street 1:3918 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3224
Practice Address - Country:US
Practice Address - Phone:703-657-6925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2025-04-15
Deactivation Date:2025-03-26
Deactivation Code:
Reactivation Date:2025-04-15
Provider Licenses
StateLicense IDTaxonomies
MDC0006935363A00000X
VA011000636363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant