Healthcare Provider Details

I. General information

NPI: 1447339957
Provider Name (Legal Business Name): NICKI AKSTINAS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11107 RACETRACK ROAD
BERLIN MD
21811-3279
US

IV. Provider business mailing address

10026 OLD OCEAN CITY BLVD BUILDING #1
BERLIN MD
21811-1288
US

V. Phone/Fax

Practice location:
  • Phone: 410-208-9761
  • Fax: 410-208-9764
Mailing address:
  • Phone: 410-641-9450
  • Fax: 410-641-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16247
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR185129
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: