Provider Demographics
NPI:1649991142
Name:FLORES, FERNANDO ANIBAL (A-GNP)
Entity type:Individual
Prefix:
First Name:FERNANDO
Middle Name:ANIBAL
Last Name:FLORES
Suffix:
Gender:M
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11102 CAVALIER CT APT 2H
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-4912
Mailing Address - Country:US
Mailing Address - Phone:615-569-6934
Mailing Address - Fax:
Practice Address - Street 1:3900 JERMANTOWN RD STE 460
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4900
Practice Address - Country:US
Practice Address - Phone:703-273-8693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001263862363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health