Healthcare Provider Details

I. General information

NPI: 1962009449
Provider Name (Legal Business Name): JULIA SANCARRANCO NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2020
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3093 BEVERLY LN UNIT A
CAMBRIDGE MD
21613-3433
US

IV. Provider business mailing address

1125 WEST ST. SUITE 200 #311
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 321-750-7699
  • Fax: 410-600-3939
Mailing address:
  • Phone: 321-750-7699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC007079
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAC003355
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberACC003355
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: