Provider Demographics
NPI:1891196788
Name:JAVILLO, ANGELICA AQUINO (CRNP)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:AQUINO
Last Name:JAVILLO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:CONCEPCION
Other - Last Name:AQUINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 E UNIVERSITY PKWY
Mailing Address - Street 2:CVDL, MEDSTAR UNION MEMORIAL HOSPITAL
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2829
Mailing Address - Country:US
Mailing Address - Phone:410-554-6642
Mailing Address - Fax:410-554-2333
Practice Address - Street 1:201 E UNIVERSITY PKWY
Practice Address - Street 2:CVDL, MEDSTAR UNION MEMORIAL HOSPITAL
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2829
Practice Address - Country:US
Practice Address - Phone:410-554-6642
Practice Address - Fax:410-554-2333
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR162372363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care