Individual provider Active NPI

Nancy A Roe, NP

  • Adult Health Nurse Practitioner
  • Virginia Beach, VA
National Provider Identifier
1861475204
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
A03703 Issued in VA
Practice address
6477 College Park SQ Ste 312
Virginia Beach, VA 23464-3611
Phone
(757) 452-6932
Fax
(757) 905-4316
NPI assigned
Nov 21, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 453123 NY
Adult Health Nurse Practitioner 363LA2200X A03703 VA Primary

Addresses

Primary practice location

6477 College Park SQ Ste 312
Virginia Beach, VA 23464-3611

Mailing address

540 Conservancy Way Apt 106
Chesapeake, VA 23323-1334
Phone (669) 411-8518

Other identifiers 1

IdentifierTypeStateIssuer
02671052MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20220923002178 VA Practitioner - Nurse Practitioner 7416922075 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
453123NYMDNurse Practitioner
A03703VAMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Medical PC Nurse Practitioner CurrentSince Oct 18, 2024 Accepting new patients
Integrated Wound Care Virginia PLLC CurrentSince Jun 1, 2022 Accepting new patients

Locations

492C Cedar Ln
Teaneck, NJ 07666
Phone (201) 357-5468

250 Skillman St
Ste 202
Brooklyn, NY 11205

414 Algonquin Rd
Hampton, VA 23661
Phone (757) 427-8516

324 King George Ave SW
Roanoke, VA 24016
Phone (540) 309-9895

Interoperability endpoints

  • Direct secure messaging: nroe@landmarkhealth-direct.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1132531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726185600000",
    "number": "1861475204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "540 CONSERVANCY WAY APT 106",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233231334",
            "telephone_number": "669-411-8518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6477 COLLEGE PARK SQ STE 312",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234643611",
            "telephone_number": "757-452-6932",
            "fax_number": "757-905-4316"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROE",
        "first_name": "NANCY",
        "middle_name": "A",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-21",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NY",
            "license": "453123",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "VA",
            "license": "A03703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02671052",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.