Provider Demographics
NPI:1437143039
Name:MUSIOL, JENNIFER ROBIN (CRNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROBIN
Last Name:MUSIOL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:J
Other - Last Name:MUSIOL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:830 MANHATTAN BEACH RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4325
Mailing Address - Country:US
Mailing Address - Phone:410-544-5954
Mailing Address - Fax:
Practice Address - Street 1:1238 PUTTY HILL AVE
Practice Address - Street 2:#6
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5844
Practice Address - Country:US
Practice Address - Phone:410-823-2726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR082133363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD019223M72Medicare PIN
MD082NL395Medicare PIN