Provider Demographics
NPI:1972861383
Name:POLTRACK, ANGELA JEAN (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:JEAN
Last Name:POLTRACK
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 ORLEANS ST
Mailing Address - Street 2:JOHNS HOPKINS HOSPITAL - CVSICU
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287-0010
Mailing Address - Country:US
Mailing Address - Phone:410-955-4826
Mailing Address - Fax:410-955-8460
Practice Address - Street 1:1800 ORLEANS ST
Practice Address - Street 2:JOHNS HOPKINS HOSPITAL - CVSICU
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0010
Practice Address - Country:US
Practice Address - Phone:410-955-4826
Practice Address - Fax:410-955-8460
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR139099363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012002325OtherANCC
MDR139099OtherMARYLAND BOARD OF NURSING - CRNP-ACUTE CARE