Provider Demographics
NPI:1538997283
Name:PUSKARICH, ASTA ELIZABETH (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:ASTA
Middle Name:ELIZABETH
Last Name:PUSKARICH
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 1:5200 CAMPBELL BLVD STE L-M
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4983
Mailing Address - Country:US
Mailing Address - Phone:443-442-1568
Mailing Address - Fax:443-442-1569
Practice Address - Street 1:5022 CAMPBELL BLVD STE L-M
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4969
Practice Address - Country:US
Practice Address - Phone:443-442-1568
Practice Address - Fax:443-442-1569
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-24
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184811163WP2201X
MDR814811363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care