Provider Demographics
NPI:1720331945
Name:TCHEFFO, CAROLINE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:
Last Name:TCHEFFO
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 1:7207 HANOVER PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2089
Mailing Address - Country:US
Mailing Address - Phone:301-447-4093
Mailing Address - Fax:240-553-7045
Practice Address - Street 1:4812 LAKEVIEW LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-4247
Practice Address - Country:US
Practice Address - Phone:240-705-3934
Practice Address - Fax:202-469-4183
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF11180833363LF0000X
DCRN1012449163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty