Provider Demographics
NPI:1659193183
Name:HERRERA, MARIANA (ACNPC-AG)
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 SECRETARIAT RUN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5528
Mailing Address - Country:US
Mailing Address - Phone:434-849-4295
Mailing Address - Fax:
Practice Address - Street 1:1225 SECRETARIAT RUN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5528
Practice Address - Country:US
Practice Address - Phone:434-849-4295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191600363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care