Provider Demographics
NPI:1205284460
Name:BEATTY, JINAYA S (DNP, CRNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:JINAYA
Middle Name:S
Last Name:BEATTY
Suffix:
Gender:
Credentials:DNP, CRNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2316 E JOPPA RD STE 1
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2808
Mailing Address - Country:US
Mailing Address - Phone:443-793-7220
Mailing Address - Fax:443-687-8705
Practice Address - Street 1:2316 E JOPPA RD STE 1
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2808
Practice Address - Country:US
Practice Address - Phone:443-793-7220
Practice Address - Fax:443-687-8705
Is Sole Proprietor?:No
Enumeration Date:2016-05-28
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR201325363LF0000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD333317500Medicaid