Healthcare Provider Details

I. General information

NPI: 1215651948
Provider Name (Legal Business Name): JENNIFER LYNNE CANAPP AGPCNP-BC, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 09/27/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11315 HOLTER RD
WHITE MARSH MD
21162-3403
US

IV. Provider business mailing address

11315 HOLTER RD
WHITE MARSH MD
21162-3403
US

V. Phone/Fax

Practice location:
  • Phone: 410-440-1475
  • Fax:
Mailing address:
  • Phone: 410-440-1475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR195887
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: