Provider Demographics
NPI:1598903270
Name:JACKSON-PARKIN, MARANDA C (CRNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARANDA
Middle Name:C
Last Name:JACKSON-PARKIN
Suffix:
Gender:F
Credentials:CRNP-BC
Other - Prefix:MS
Other - First Name:MARANDA
Other - Middle Name:C
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:100 IRVING STREET
Mailing Address - Street 2:MEDSTAR DIABETES INSTITUTE, ROOM 4131
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010
Mailing Address - Country:US
Mailing Address - Phone:480-703-0248
Mailing Address - Fax:
Practice Address - Street 1:901 HARRY S TRUMAN DR N
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-5477
Practice Address - Country:US
Practice Address - Phone:240-677-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR168458364S00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist