Provider Demographics
NPI:1053709907
Name:BOYLE, PENNY J (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:J
Last Name:BOYLE
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 1:490 CADMUS LN
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4091
Mailing Address - Country:US
Mailing Address - Phone:410-770-5250
Mailing Address - Fax:
Practice Address - Street 1:490 CADMUS LN
Practice Address - Street 2:SUITE 102
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-4091
Practice Address - Country:US
Practice Address - Phone:410-770-5250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-30
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR111539363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily