Healthcare Provider Details

I. General information

NPI: 1568306249
Provider Name (Legal Business Name): JOHANNA J SALAZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 DEFENSE ST
ANNAPOLIS MD
21401-3103
US

IV. Provider business mailing address

1673 BAY HEAD RD
ANNAPOLIS MD
21409-5712
US

V. Phone/Fax

Practice location:
  • Phone: 443-784-9714
  • Fax:
Mailing address:
  • Phone: 443-784-9714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR254593
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: