Provider Demographics
NPI:1154310613
Name:PROKOP, ERIN (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:PROKOP
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MACPHAIL RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4309
Mailing Address - Country:US
Mailing Address - Phone:410-638-8900
Mailing Address - Fax:
Practice Address - Street 1:615 W MACPHAIL RD
Practice Address - Street 2:SUITE 106
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4309
Practice Address - Country:US
Practice Address - Phone:410-638-8900
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR136755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDUP1329Medicare UPIN