| Tidewater Family Practice, P.c. | |
|
4660 Haygood Rd Virginia Beach VA 23455-5436 | |
| (757) 460-0243 | |
| (757) 460-1011 |
| Full Name | Tidewater Family Practice, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 4660 Haygood Rd, Virginia Beach, Virginia |
| Authorized Official Name and Position | David Brannon Holt (OWNER) |
| Authorized Official Contact | 7574600243 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tidewater Family Practice, P.c. 4660 Haygood Rd Virginia Beach VA 23455-5436 Ph: (757) 460-0243 | Tidewater Family Practice, P.c. 4660 Haygood Rd Virginia Beach VA 23455-5436 Ph: (757) 460-0243 |
| NPI Number | 1750462628 |
|---|---|
| Provider Enumeration Date | 10/18/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1951391796 |
|---|---|
| Medicare Enrollment ID | O20040514000188 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750462628 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Eric M Byman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1962457275 PECOS PAC ID: 7911924253 Enrollment ID: I20051026000993 |
| Provider Name | David B Holt |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508805888 PECOS PAC ID: 3476543216 Enrollment ID: I20100505000455 |
| Provider Name | Jennifer A Kiggans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033463476 PECOS PAC ID: 7517110737 Enrollment ID: I20130118000356 |
| Provider Name | Jennifer Lynn Ladeveze |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629585435 PECOS PAC ID: 8224398235 Enrollment ID: I20180213002145 |
| Provider Name | Deanna L Kline |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841702107 PECOS PAC ID: 7113281759 Enrollment ID: I20180507000583 |
| Provider Name | Melinda L Stone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790087799 PECOS PAC ID: 3577932979 Enrollment ID: I20221207000382 |
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