Basic Information
| Provider Information | |||||||||
| NPI: | 1174600670 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAAFFE | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 ACADEMY AVENUE | ||||||||
| Address2: | ACADEMY CROSSING MEDICAL PLAZA | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574836404 | ||||||||
| FaxNumber: | 7574830737 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 ACADEMY AVENUE | ||||||||
| Address2: | ACADEMY CROSSING MEDICAL PLAZA | ||||||||
| City: | PORTSMOUTH | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7574836404 | ||||||||
| FaxNumber: | 7574830737 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 0001050835 | VA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 057455 | 01 | VA | ANTHEM | OTHER | 7709510 | 05 | VA | MEDICAID |