Active NPI
Jacqueline Devita
- Family Nurse Practitioner
- Baltimore, MD
National Provider Identifier
1134629553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- R154589
- Practice address
- 1800 E Fort Ave
Baltimore, MD 21230-5338 - Phone
- (410) 746-2577
- NPI assigned
- Feb 13, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R154589 | MD | Primary |
Addresses
Primary practice location
1800 E Fort Ave
Baltimore, MD 21230-5338
Mailing address
1800 E Fort Ave
Baltimore, MD 21230-5338
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181205000050 | MD | Practitioner - Nurse Practitioner | 6406190255 | Practice locations: Phoenix, MD |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518480000000",
"number": "1134629553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 E FORT AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212305338"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1800 E FORT AVE",
"city": "BALTIMORE",
"state": "MD",
"postal_code": "212305338",
"telephone_number": "410-746-2577"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEVITA",
"first_name": "JACQUELINE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-02-13",
"last_updated": "2018-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MD",
"license": "R154589",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Baltimore, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.