Provider Demographics
NPI:1174591606
Name:JUDGE, TINA ANN (FNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:JUDGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 EREM WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-2132
Mailing Address - Country:US
Mailing Address - Phone:540-256-7302
Mailing Address - Fax:
Practice Address - Street 1:9 PINNACLE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-2366
Practice Address - Country:US
Practice Address - Phone:540-688-2646
Practice Address - Fax:540-688-2656
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAMJ0925985363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7794398Medicaid
VA7794398Medicaid
VA001803C64Medicare ID - Type Unspecified