Individual
JARLISA MICKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, A-GPCNP-C
Contact information
Practice address
10175 LITTLE PATUXENT PKWY, COLUMBIA, MD 21044-2655
(501) 553-1153
Mailing address
10175 LITTLE PATUXENT PKWY, COLUMBIA, MD 21044-2655
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
220528
AR
Other
Enumeration date
08/19/2022
Last updated
08/26/2024
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