Provider Demographics
NPI:1639849698
Name:COLE, CLARISSA (NP-C)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7803 LONGRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-3831
Mailing Address - Country:US
Mailing Address - Phone:410-624-9810
Mailing Address - Fax:
Practice Address - Street 1:7803 LONGRIDGE RD
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-3831
Practice Address - Country:US
Practice Address - Phone:410-624-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR132603363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily