Healthcare Provider Details

I. General information

NPI: 1083017446
Provider Name (Legal Business Name): JASMINE OPHELIA PEGA CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 06/12/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD STE 150
HAGERSTOWN MD
21742-6755
US

IV. Provider business mailing address

17355 KILPATRICK CT
HAGERSTOWN MD
21740-1090
US

V. Phone/Fax

Practice location:
  • Phone: 301-665-4825
  • Fax: 301-665-4826
Mailing address:
  • Phone: 240-382-4347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR183401
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP033078
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR183401
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: