1104507193 NPI number — DR. INGRID FLORES DNP, CRNP-PC

Table of content: DR. INGRID FLORES DNP, CRNP-PC (NPI 1104507193)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104507193 NPI number — DR. INGRID FLORES DNP, CRNP-PC

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
FLORES

Provider First Name:
INGRID

Provider Middle Name:

Provider Name Prefix Text:
DR.

Provider Name Suffix Text:

Provider Credential Text:
DNP, CRNP-PC

Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:
FLORES

Provider Other First Name:
INGRID

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:
DNP, CRNP-PC

Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1104507193

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
07/31/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14813 EASTWAY DR

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
SILVER SPRING

Provider Business Mailing Address State Name:
MD

Provider Business Mailing Address Postal Code:
20905-5604

Provider Business Mailing Address Country Code:
US

Provider Business Mailing Address Telephone Number:
443-333-7881

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 W EDMONSTON DR STE 502

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:
ROCKVILLE

Provider Business Practice Location Address State Name:
MD

Provider Business Practice Location Address Postal Code:
20852-1222

Provider Business Practice Location Address Country Code:
US

Provider Business Practice Location Address Telephone Number:
301-284-1234

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
07/31/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 363LP0200X , with the licence number: R224040 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .