Healthcare Provider Details

I. General information

NPI: 1730505546
Provider Name (Legal Business Name): PATRICIA CARPENTER RN, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2014
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MAIDEN CHOICE LN
CATONSVILLE MD
21228-3632
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 410-247-5602
  • Fax: 410-242-1756
Mailing address:
  • Phone: 410-247-5602
  • Fax: 410-242-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR139613
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR139613
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: