Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 0024177680 | VA |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 0024177680 | VA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 0024177680 | VA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 0024177680 | VA |
NPI | 1003455122 |
---|---|
Provider Name | Tonja Marie Devolgado |
First Address | Virginia Beach, VA 23456-5860 |
Second Address | Virginia Beach, VA 23456-0179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2020 |
Last Update Date | 09/12/2021 |