Provider Demographics
NPI:1063909398
Name:HANCOCK, JOHN A (CRNP, AGNP-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:CRNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3177
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-3177
Mailing Address - Country:US
Mailing Address - Phone:410-548-2343
Mailing Address - Fax:844-332-3891
Practice Address - Street 1:9715 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3500
Practice Address - Country:US
Practice Address - Phone:410-548-2343
Practice Address - Fax:844-332-3891
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR193259363LP2300X, 363L00000X
DELP-0010374363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner