Provider Demographics
NPI:1811445745
Name:SRINIVAS, PRIYA P (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:PRIYA
Middle Name:P
Last Name:SRINIVAS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9091 SNOWDEN RIVER PKWY # 1085
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1657
Mailing Address - Country:US
Mailing Address - Phone:214-238-3074
Mailing Address - Fax:443-232-0693
Practice Address - Street 1:9091 SNOWDEN RIVER PKWY # 1085
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1657
Practice Address - Country:US
Practice Address - Phone:240-547-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132280363LF0000X
MDAC005209363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP132280OtherLICENSE
TX351460601Medicaid
MD247NLNTPMedicaid