Healthcare Provider Details

I. General information

NPI: 1639516933
Provider Name (Legal Business Name): SOFIA J ARNOLD CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2013
Last Update Date: 10/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15520 ANNAPOLIS RD
BOWIE MD
20715-3002
US

IV. Provider business mailing address

15520 ANNAPOLIS RD
BOWIE MD
20715-3002
US

V. Phone/Fax

Practice location:
  • Phone: 443-481-6549
  • Fax: 443-481-6515
Mailing address:
  • Phone: 443-481-6549
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR216032
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: