Organization
MAGNOLIA HEALTH CARE LLC
Active
Parent organization
MAGNOLIA HEALTH CARE LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MAGNOLIA HEALTH CARE LLC
Authorized official
SHAQUILLA VAZQUEZ CLARK DNP (OWNER)
(301) 715-3010
Entity
Organization
Contact information
Practice address
2407 BANEBERRY LN, GAMBRILLS, MD 21054-1992
(410) 793-2634
Mailing address
12530 FAIRWOOD PKWY STE 102, BOWIE, MD 20720-6357
(301) 715-3010
(410) 220-8162
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
11/11/2025
Last updated
01/02/2026
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