Healthcare Provider Details

I. General information

NPI: 1841567856
Provider Name (Legal Business Name): STEPHANIE NICOLE JARVIS CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE NICOLE ROBBINS CRNP

II. Dates (important events)

Enumeration Date: 11/18/2011
Last Update Date: 02/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 BERKMORE PL STE 1A
BERKELEY SPRINGS WV
25411-6247
US

IV. Provider business mailing address

109 RAYLOC DR
HANCOCK MD
21750-1518
US

V. Phone/Fax

Practice location:
  • Phone: 304-258-5790
  • Fax: 304-258-3745
Mailing address:
  • Phone: 301-678-5187
  • Fax: 301-678-5797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC000969
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: