Provider Demographics
NPI:1184610594
Name:COLQUITT, RACHEL R (FNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:COLQUITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:RACHEL
Other - Middle Name:A
Other - Last Name:RAUSCHBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:43300 SOUTHERN WALK PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:BROADLANDS
Practice Address - State:VA
Practice Address - Zip Code:20148-4463
Practice Address - Country:US
Practice Address - Phone:571-252-7353
Practice Address - Fax:571-223-1797
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184610594Medicaid
080005185Medicare ID - Type Unspecified
VAVAA113517Medicare PIN
VA1184610594Medicaid