Provider Demographics
NPI:1669083416
Name:RELYEA, CIERRA JADE (FNP)
Entity type:Individual
Prefix:
First Name:CIERRA
Middle Name:JADE
Last Name:RELYEA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3390 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-1724
Mailing Address - Country:US
Mailing Address - Phone:850-260-2712
Mailing Address - Fax:
Practice Address - Street 1:3390 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-1724
Practice Address - Country:US
Practice Address - Phone:850-260-2712
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-14
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily