Healthcare Provider Details

I. General information

NPI: 1194698779
Provider Name (Legal Business Name): PRUDENCE AYUK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 ANNAPOLIS RD STE 100
GLENN DALE MD
20769-9183
US

IV. Provider business mailing address

PO BOX 7321
LARGO MD
20792-7321
US

V. Phone/Fax

Practice location:
  • Phone: 301-464-7601
  • Fax: 866-885-9817
Mailing address:
  • Phone: 301-464-7601
  • Fax: 866-885-9817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR238816
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN500010088
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: