Provider Demographics
NPI:1376910331
Name:WHITLOCK, BREANNA (MS, FNP-BC)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:WHITLOCK
Suffix:
Gender:F
Credentials:MS, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 4100
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-7837
Mailing Address - Country:US
Mailing Address - Phone:301-530-5151
Mailing Address - Fax:301-530-7735
Practice Address - Street 1:6420 ROCKLEDGE DR
Practice Address - Street 2:SUITE 4100
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-7837
Practice Address - Country:US
Practice Address - Phone:301-530-5151
Practice Address - Fax:301-530-7735
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC001604363LF0000X
VA0001260669163W00000X
CO205443163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse