Provider Demographics
NPI:1023443652
Name:NWANA, FLORENCE A (CRNP-PMH)
Entity type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:A
Last Name:NWANA
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14601 TALLYRAND TRAIL
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-6943
Mailing Address - Country:US
Mailing Address - Phone:443-803-5391
Mailing Address - Fax:
Practice Address - Street 1:13639 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5095
Practice Address - Country:US
Practice Address - Phone:301-604-4830
Practice Address - Fax:301-604-4929
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR128581363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD422556200Medicaid