# FITZGERALD PRIMARY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033802848
- **Authorized official:** TARNISHA LATASHA FITZGERALD (OWNER)
- **Authorized official phone:** (443) 763-7154

## Contact information

- **Practice address:** 2232 E MONUMENT ST, BALTIMORE, MD 21205-2431
- **Practice address phone:** (667) 207-3552
- **Mailing address:** 2232 E MONUMENT ST, BALTIMORE, MD 21205-2431
- **Mailing address phone:** (667) 207-3552

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 05/29/2023
- **Last updated:** 05/16/2024