Healthcare Provider Details

I. General information

NPI: 1144923558
Provider Name (Legal Business Name): ZIANQUA HILLIARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10175 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-2655
US

IV. Provider business mailing address

10175 LITTLE PATUXENT PKWY
COLUMBIA MD
21044-2655
US

V. Phone/Fax

Practice location:
  • Phone: 855-247-8474
  • Fax:
Mailing address:
  • Phone: 855-247-8474
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number213770
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5018043
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: