MEDICARE: CLARISSA COLE NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R132603	MD

General Provider Information

NPI Number	:	1639849698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARISSA COLE NP-C

Provider Business Mailing Address
First Line	:	7803 LONGRIDGE RD
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-3831
Country	:	US
Telephone Number	:	410-624-9810
Fax Number	:

Provider Business Practice Location Address
First Line	:	7803 LONGRIDGE RD
Second Line	:
City	:	NOTTINGHAM
State	:	MD
Zip	:	21236-3831
Country	:	US
Telephone Number	:	410-624-9810
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2021
Last Update Date	:	09/20/2021

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