Healthcare Provider Details

I. General information

NPI: 1790505576
Provider Name (Legal Business Name): GIOVANNA MARIE KOLOFER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/15/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 MEDICAL PKWY STE 1012000
ANNAPOLIS MD
21401-3742
US

IV. Provider business mailing address

8 S ELLWOOD AVE
BALTIMORE MD
21224-2241
US

V. Phone/Fax

Practice location:
  • Phone: 410-268-8862
  • Fax:
Mailing address:
  • Phone: 831-210-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR251054
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: