Healthcare Provider Details

I. General information

NPI: 1952811465
Provider Name (Legal Business Name): ANGELA V GIMOSE MSN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 BRIGGS CHANEY RD
SILVER SPRING MD
20904-4811
US

IV. Provider business mailing address

7604 HEARTHSIDE WAY UNIT 1036
ELKRIDGE MD
21075-7365
US

V. Phone/Fax

Practice location:
  • Phone: 301-493-2400
  • Fax: 240-235-7075
Mailing address:
  • Phone: 443-858-8126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR197579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: