Provider Demographics
NPI:1528449550
Name:MAXWELL, TAMIKA (FNP-C)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TAMIKA
Other - Middle Name:
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7704 MATAPEAKE BUSINESS DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-3036
Mailing Address - Country:US
Mailing Address - Phone:301-242-5699
Mailing Address - Fax:
Practice Address - Street 1:7704 MATAPEAKE BUSINESS DR STE 110
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-3036
Practice Address - Country:US
Practice Address - Phone:301-242-5699
Practice Address - Fax:301-782-2221
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR174533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily