Provider Demographics
NPI:1538904297
Name:BOSS, TRAVIS (CRNP)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:BOSS
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 VETERANS HWY STE 111
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8601 VETERANS HWY
Practice Address - Street 2:SUITE 111
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108
Practice Address - Country:US
Practice Address - Phone:410-553-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR231262363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care