Provider Demographics
NPI:1063779502
Name:GIFFORD, ERICA LYNN (FNP-C)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:LYNN
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:LYNN
Other - Last Name:DENTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 MALCOLM DR STE C
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-6160
Mailing Address - Country:US
Mailing Address - Phone:410-857-2300
Mailing Address - Fax:410-367-2048
Practice Address - Street 1:410 MALCOLM DR STE C
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6160
Practice Address - Country:US
Practice Address - Phone:410-857-2300
Practice Address - Fax:410-367-2048
Is Sole Proprietor?:No
Enumeration Date:2012-04-23
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR216206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily