Provider Demographics
NPI:1992791065
Name:BOYD, CHARISSA YVETTE (MSN)
Entity type:Individual
Prefix:
First Name:CHARISSA
Middle Name:YVETTE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 MCCORMICK DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5326
Mailing Address - Country:US
Mailing Address - Phone:571-239-1243
Mailing Address - Fax:877-804-6629
Practice Address - Street 1:1801 MCCORMICK DR
Practice Address - Street 2:SUITE 180
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5326
Practice Address - Country:US
Practice Address - Phone:571-239-1243
Practice Address - Fax:877-804-6629
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR140627363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD018518M72Medicare UPIN
MD08NM983Medicare PIN