Healthcare Provider Details

I. General information

NPI: 1316655723
Provider Name (Legal Business Name): JAZZMIN HOLLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13921 ROCKINGHAM RD
GERMANTOWN MD
20874-2230
US

IV. Provider business mailing address

267 KENTLANDS BOULEVARD PMB 5231
GAITHERSBURG MD
20878
US

V. Phone/Fax

Practice location:
  • Phone: 240-635-9275
  • Fax: 240-332-5890
Mailing address:
  • Phone: 240-635-9275
  • Fax: 240-332-5890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR202068
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR202068
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: