Magnolia Health Care LLC

Primary specialty

Wound Care Registered NurseTaxonomy code 163WW0000X

Legal business name

MAGNOLIA HEALTH CARE LLC

Practice address

2407 Baneberry LN
Gambrills, MD 21054-1992

Phone

(410) 793-2634

NPI assigned

Nov 11, 2025

Organization subpart

Yes

Parent organization

MAGNOLIA HEALTH CARE LLCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Shaquilla Vazquez Clark, DNP

Title

Owner

Phone

(301) 715-3010

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Magnolia Health Care LLC

  • Family Nurse Practitioner
  • Gambrills, MD
  • NPI 1154139640

  O20251031004141

  Same enrollment

Tax ID family

Magnolia Health Care LLC2 organizations share this tax ID, including this one

Part of

Magnolia Health Care LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Magnolia Health Care LLC

  • Family Nurse Practitioner
  • Gambrills, MD
  • NPI 1154139640
  NPD tax ID

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Magnolia Health Care LLC

  • Family Nurse Practitioner
  • Gambrills, MD
  • NPI 1154139640
  NPPES parent name

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shaquilla Vazquez, DNP CRNP FNP-BC FNPC

  • Family Nurse Practitioner
  • Fairfax, VA
  • NPI 1538869789

  Family

  NPD
• Aaron Mikel Clark, LCSW

  • Clinical Social Worker
  • Haymarket, VA
  • NPI 1487984837
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1762819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767312000000",
    "number": "1225908445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12530 FAIRWOOD PKWY STE 102",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207206357",
            "telephone_number": "301-715-3010",
            "fax_number": "410-220-8162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2407 BANEBERRY LN",
            "city": "GAMBRILLS",
            "state": "MD",
            "postal_code": "210541992",
            "telephone_number": "410-793-2634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA HEALTH CARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MAGNOLIA HEALTH CARE LLC",
        "enumeration_date": "2025-11-11",
        "last_updated": "2026-01-02",
        "certification_date": "2026-01-02",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ CLARK",
        "authorized_official_first_name": "SHAQUILLA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-715-3010",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Maryland CVS Pharmacy LLC

• All providers in Gambrills, MD
• Wound Care Registered Nurse in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.