Provider Demographics
NPI:1770635187
Name:JANTAC, KATHERINE DELGADO (GNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:DELGADO
Last Name:JANTAC
Suffix:
Gender:F
Credentials:GNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6334 CEDAR LN
Mailing Address - Street 2:SUITE 103
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3898
Mailing Address - Country:US
Mailing Address - Phone:410-531-2355
Mailing Address - Fax:410-531-7041
Practice Address - Street 1:6334 CEDAR LN
Practice Address - Street 2:SUITE 103
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3898
Practice Address - Country:US
Practice Address - Phone:410-531-2355
Practice Address - Fax:410-531-7041
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121680363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9680-0062OtherCAREFIRST BCBS OF DC
263108258OtherTRICARE NORTH
83-20152OtherEVERCARE
P516-0001OtherCAREFIRST BCBS OF DC
MD417307400Medicaid
83-15248OtherEVERCARE
948993-02OtherCAREFIRST BCBS OF MD
948993-01OtherCAREFIRST BCBS OF MD
P00748106Medicare PIN
P00690842Medicare PIN
9680-0062OtherCAREFIRST BCBS OF DC
P516-0001OtherCAREFIRST BCBS OF DC