Provider Demographics
NPI:1245782010
Name:FITZPATRICK, GRACE (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:GRACE
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 PATUXENT WOODS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1526
Mailing Address - Country:US
Mailing Address - Phone:301-575-8080
Mailing Address - Fax:
Practice Address - Street 1:9710 PATUXENT WOODS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1526
Practice Address - Country:US
Practice Address - Phone:301-575-8080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR207909363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily