Healthcare Provider Details

I. General information

NPI: 1720384043
Provider Name (Legal Business Name): GEORGIA NESSI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2011
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12335 QUIET OWL LN
BOWIE MD
20720-4308
US

IV. Provider business mailing address

12335 QUIET OWL LN
BOWIE MD
20720-4308
US

V. Phone/Fax

Practice location:
  • Phone: 443-762-6390
  • Fax:
Mailing address:
  • Phone: 443-762-6390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR192485
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR192485
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR192485
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: