Provider Demographics
NPI:1508747981
Name:DOUGLAS, PAMELA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4975 DERRYFIELD CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3186
Mailing Address - Country:US
Mailing Address - Phone:410-746-8984
Mailing Address - Fax:
Practice Address - Street 1:655 NEW YORK AVE NW STE 2175
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4593
Practice Address - Country:US
Practice Address - Phone:240-444-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1051382363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily