Healthcare Provider Details

I. General information

NPI: 1275755076
Provider Name (Legal Business Name): ANGELA MARIE JEFFERSON CRNP-F
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 MOUNT HERMON RD STE A
SALISBURY MD
21804-5109
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-2133
  • Fax: 410-548-3361
Mailing address:
  • Phone: 410-581-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR165285
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: