Healthcare Provider Details

I. General information

NPI: 1578554838
Provider Name (Legal Business Name): JO ANN SERAFINI CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2568A RIVA RD SUITE 103
ANNAPOLIS MD
21401-7445
US

IV. Provider business mailing address

1171 AMBER WAY
OWINGS MD
20736-3501
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-7667
  • Fax: 410-224-7007
Mailing address:
  • Phone: 410-286-3825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR148953
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: