Healthcare Provider Details

I. General information

NPI: 1134836828
Provider Name (Legal Business Name): SOPHONIE MIRSHAMA JEAN BAPTISTE CRNP, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 08/24/2025
Certification Date: 08/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10770 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4439
US

IV. Provider business mailing address

5100 E VIRGINIA BEACH BLVD
NORFOLK VA
23502-3413
US

V. Phone/Fax

Practice location:
  • Phone: 240-663-5467
  • Fax: 301-517-9414
Mailing address:
  • Phone: 757-261-6475
  • Fax: 855-939-7173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTPAN3581
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF350847
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187951
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC004748
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: