Tania Jeanette Modeliste, NURSE PRACTITIONER

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

0024183611 Issued in VA

Practice address

48 Newmarket SQ
Newport News, VA 23605-2721

Phone

(757) 825-8030

Fax

(757) 847-9149

NPI assigned

Apr 22, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR, VA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

PMR Virginia Holding LLCGroup PAC ID 9537576608, 19 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• PMR Virginia Holding, LLC

  • Specialist
  • Miami Gardens, FL
  • NPI 1083167001

  VA

  Medicare reassignment Care Compare group NPD
• Mid-Atlantic Post Acute & Long Term Care PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225557556

  Family

  Medicare reassignment NPD
• SE Virginia Value Based Care, LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Norfolk, VA
  • NPI 1225720501
  Medicare reassignment NPD
• Jencare Neighborhood Medical East Richmond, LLC

  • Internal Medicine Physician
  • Richmond, VA
  • NPI 1891089454
  NPD (past)
• Post Acute Medical PLLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Lanham, MD
  • NPI 1730713025
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740441600000",
    "number": "1346984606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48 NEWMARKET SQ",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236052721",
            "telephone_number": "757-825-8030",
            "fax_number": "757-847-9149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 NEWMARKET SQ",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236052721",
            "telephone_number": "757-825-8030",
            "fax_number": "757-847-9149"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MODELISTE",
        "first_name": "TANIA",
        "middle_name": "JEANETTE",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-22",
        "last_updated": "2025-02-25",
        "certification_date": "2025-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "F11210527",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "202205372NP-PP",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024183611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "202205372NP-PP",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kristi Vergena Mizelle, M.D.
• MMS Norfolk, Inc.
• Mobile Podiatry
• Mobilitymed Transport LLC
• Richard Dale Mocabee, P.T.
• Emad Said Mohamed Khalil, MD
• Sathish Mohan, M.D.
• Melissa Mohnal, DO
• Holly Alanna Catlin Mollenkopf, M.D.
• Momentum 180 LLC

• Family Nurse Practitioner in Newport News, VA
• Providers in Newport News, VA by specialty
• Family Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.