Provider Demographics
NPI:1922569482
Name:PETERSON, JOY (FNP-C)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1438 DEFENSE HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-2021
Mailing Address - Country:US
Mailing Address - Phone:410-697-1605
Mailing Address - Fax:410-697-1693
Practice Address - Street 1:1438 DEFENSE HWY STE 201
Practice Address - Street 2:
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054-2021
Practice Address - Country:US
Practice Address - Phone:410-697-1605
Practice Address - Fax:410-697-1693
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR199981363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily