Healthcare Provider Details

I. General information

NPI: 1033004338
Provider Name (Legal Business Name): AFRA ALIZADEH MSN, CRNP, AGPCNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24005 SANTA ANITA CT
DAMASCUS MD
20872-2161
US

IV. Provider business mailing address

24005 SANTA ANITA CT
DAMASCUS MD
20872-2161
US

V. Phone/Fax

Practice location:
  • Phone: 240-899-6970
  • Fax:
Mailing address:
  • Phone: 240-899-6970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberR255065
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: