Provider Demographics
NPI:1881627347
Name:SERRANO, PRISCILLA ANNE (PA)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANNE
Last Name:SERRANO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5226 INDIAN RIVER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-6179
Mailing Address - Country:US
Mailing Address - Phone:757-216-4030
Mailing Address - Fax:757-216-4029
Practice Address - Street 1:5226 INDIAN RIVER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6179
Practice Address - Country:US
Practice Address - Phone:757-216-4030
Practice Address - Fax:757-216-4029
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001354363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant