Provider Demographics
NPI:1235804188
Name:NORMAN, JIMMY (DNP, MSN, RN, APHN)
Entity Type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:
Last Name:NORMAN
Suffix:
Gender:M
Credentials:DNP, MSN, RN, APHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10058 SELKIE LN
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-4711
Mailing Address - Country:US
Mailing Address - Phone:301-615-3274
Mailing Address - Fax:
Practice Address - Street 1:10058 SELKIE LN
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-4711
Practice Address - Country:US
Practice Address - Phone:301-814-0357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR164197251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health