Healthcare Provider Details

I. General information

NPI: 1740293042
Provider Name (Legal Business Name): TRICIA FLETCHER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR NICU/PEDS
BALTIMORE MD
21237-3901
US

IV. Provider business mailing address

9000 FRANKLIN SQUARE DR
BALTIMORE MD
21237-3901
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7050
  • Fax: 443-777-6147
Mailing address:
  • Phone: 443-777-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR126628
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberR126628
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License NumberR126628
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: