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General NPI Number Information
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NPI Number | 1083012439
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Entity Type | Individual
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Provider Name | REBECCA TARGOFF FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/17/2014
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 9 SAINT PAUL ST 2ND FLOOR
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City | BOONSBORO
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State | MD
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Zip | 21713-1334
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Country | US
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Telephone | 301-432-6897
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Fax |
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Provider Business Mailing Address
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Address Line | 7 GRANITE PLACE #14
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City | GAITHERSBURG
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State | MD
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Zip | 20878
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Country | US
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Telephone | 240-631-1170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R186190
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License Number State | MD
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