Provider Demographics
NPI:1073006417
Name:FLYNN, SOPHIA (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:SOPHIA
Middle Name:
Last Name:FLYNN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9218 WOODCREEK CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1544
Mailing Address - Country:US
Mailing Address - Phone:443-225-8283
Mailing Address - Fax:
Practice Address - Street 1:2480 ROXBURY MILLS RD STE 10
Practice Address - Street 2:
Practice Address - City:GLENWOOD
Practice Address - State:MD
Practice Address - Zip Code:21738-9718
Practice Address - Country:US
Practice Address - Phone:443-423-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-11
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183511363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily