Healthcare Provider Details

I. General information

NPI: 1124466537
Provider Name (Legal Business Name): MICHELLE JOFFE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 DUNDALK AVE
DUNDALK MD
21222
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DR # 2110
BALTIMORE MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-288-4800
  • Fax:
Mailing address:
  • Phone: 410-933-5412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1018395
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: