Provider Demographics
NPI:1235992637
Name:DEL PUPPO, JAMIE MARIE (AGNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:MARIE
Last Name:DEL PUPPO
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PROSPECT BAY DR W
Mailing Address - Street 2:
Mailing Address - City:GRASONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21638-1185
Mailing Address - Country:US
Mailing Address - Phone:410-294-8679
Mailing Address - Fax:
Practice Address - Street 1:2540 CENTREVILLE RD
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MD
Practice Address - Zip Code:21617-2681
Practice Address - Country:US
Practice Address - Phone:410-758-4432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR185776363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care