Provider Demographics
NPI:1659658052
Name:CANLAS, CAMILLE AVA LOANZON (CRNP)
Entity Type:Individual
Prefix:
First Name:CAMILLE AVA
Middle Name:LOANZON
Last Name:CANLAS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:AVA
Other - Last Name:LOANZON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:909 RIDGEBROOK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9476
Mailing Address - Country:US
Mailing Address - Phone:443-383-9300
Mailing Address - Fax:301-790-1377
Practice Address - Street 1:10175 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2655
Practice Address - Country:US
Practice Address - Phone:800-561-0861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-14
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR188878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily