Provider Demographics
NPI:1265136246
Name:DEBOSE, GINGER (AGPC NP-BC)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:DEBOSE
Suffix:
Gender:F
Credentials:AGPC NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3235 ACADEMY AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3200
Mailing Address - Country:US
Mailing Address - Phone:757-484-9400
Mailing Address - Fax:757-484-8809
Practice Address - Street 1:3235 ACADEMY AVE STE 301
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3200
Practice Address - Country:US
Practice Address - Phone:757-484-9400
Practice Address - Fax:757-484-8809
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024186826363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology