Provider Demographics
NPI:1770913816
Name:WOROBEY, JASON (FNP-BC)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:WOROBEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 MAYO RD STE 204
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1847
Mailing Address - Country:US
Mailing Address - Phone:443-223-2479
Mailing Address - Fax:443-499-2248
Practice Address - Street 1:69 MAYO RD STE 204
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1847
Practice Address - Country:US
Practice Address - Phone:443-223-2479
Practice Address - Fax:443-223-2479
Is Sole Proprietor?:No
Enumeration Date:2013-11-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR203622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5321417600Medicaid
MD5321417600Medicaid