Healthcare Provider Details

I. General information

NPI: 1235470147
Provider Name (Legal Business Name): THERESA RUGALLA BOOKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THERESA RUGALLA CRNP

II. Dates (important events)

Enumeration Date: 03/04/2013
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 JENNIFER RD STE 105
ANNAPOLIS MD
21401-7972
US

IV. Provider business mailing address

PO BOX 96489
PHOENIX AZ
85072-6489
US

V. Phone/Fax

Practice location:
  • Phone: 443-775-3994
  • Fax: 844-572-2789
Mailing address:
  • Phone: 443-775-3994
  • Fax: 844-572-2789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR184354
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP012500
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: