=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659221802
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FULL CIRCLE MEDICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2026
-----------------------------------------------------
Last Update Date | 01/29/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5000 THAYER CTR STE C
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21550-1139
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-520-3036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 STEVENS CIR APT 2A
-----------------------------------------------------
City | ABERDEEN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21001-2785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 667-520-3036
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NATASHA ROACH
-----------------------------------------------------
Credential | CRNP
-----------------------------------------------------
Telephone | 667-520-3036
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------