Healthcare Provider Details

I. General information

NPI: 1396986915
Provider Name (Legal Business Name): JEANETTE CAROLINE ROLLINS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29948 THREE NOTCH RD UNIT 1
CHARLOTTE HALL MD
20622-9998
US

IV. Provider business mailing address

5 GARRETT AVE
LA PLATA MD
20646-5960
US

V. Phone/Fax

Practice location:
  • Phone: 301-609-5044
  • Fax:
Mailing address:
  • Phone: 301-609-4539
  • Fax: 301-609-5370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP3377732
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAC007245
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: