Provider Demographics
NPI:1891470142
Name:DRAKE'S MOBILE HEALTH SERVICES.LLC
Entity Type:Organization
Organization Name:DRAKE'S MOBILE HEALTH SERVICES.LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHAKEISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVIS-DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:410-805-3781
Mailing Address - Street 1:3700 COLUMBUS DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6122
Mailing Address - Country:US
Mailing Address - Phone:410-805-3781
Mailing Address - Fax:
Practice Address - Street 1:3700 COLUMBUS DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6122
Practice Address - Country:US
Practice Address - Phone:410-805-3781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRAKE'S MOBILE HEALTH SERVICES.LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1366800211OtherNPPES