Basic Information
| Provider Information | |||||||||
| NPI: | 1710355375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROARK | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5618 WHEELWRIGHT WAY | ||||||||
| Address2: | |||||||||
| City: | HAYMARKET | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201693186 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 21785 FILIGREE CT | ||||||||
| Address2: | STE 100 | ||||||||
| City: | ASHBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201476213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035541100 | ||||||||
| FaxNumber: | 7035541122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2015 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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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 | 363LF0000X | 0024172916 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.