Provider Demographics
NPI:1720628266
Name:GLADSTON, JOY REBEKAH (ACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:REBEKAH
Last Name:GLADSTON
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 WOODS WAY
Mailing Address - Street 2:
Mailing Address - City:STATE FARM
Mailing Address - State:VA
Mailing Address - Zip Code:23160-0002
Mailing Address - Country:US
Mailing Address - Phone:804-372-4799
Mailing Address - Fax:
Practice Address - Street 1:3600 WOODS WAY
Practice Address - Street 2:
Practice Address - City:STATE FARM
Practice Address - State:VA
Practice Address - Zip Code:23160-0002
Practice Address - Country:US
Practice Address - Phone:804-372-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-13
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173111363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024173111OtherLISCENSED NURSE PRACTITIONER
VA0001199040OtherREGISTERED NURSE