Most Relevant Information
Provider Data
| NPI Number: | 1003289729 |
| Provider Name: | CAROL GAVIN PMHNP |
| Entity Type: | Individual |
| Taxonomy Code: | 363L00000X |
| Specialty: | Nurse Practitioner |
| License Number: | 0024173036 |
Most Important Dates
| Enumeration Date: | 11/03/2015 |
| Last Updated: | 12/30/2021 |
Provider Practice Location
19 FORT EVANS RD NE STE C
LEESBURG
VA
201764487
Practice Location Phone/Fax
| Phone: | 7037372110 |
| Fax: | 7037372111 |
Provider Mailing Location
19 FORT EVANS RD NE STE C
LEESBURG
VA
201764487
Provider Mailing Phone/Fax
| Phone: | 7037372110 |
| Fax: | 7037372111 |