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MAGNOLIA HEALTH CARE LLC
NPI 1154139640
Nurse Practitioner - Family in Gambrills, MD

Active since December 30, 2024
2407 BANEBERRY LN, GAMBRILLS, MD 21054(301) 715-3010(410) 220-8162 Get Directions Write a Review

NPPES record last updated: January 2, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jan 2, 2026, Dec 30, 2024 (2 updates tracked since 2024).

About Magnolia Health Care Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAGNOLIA HEALTH CARE LLC (NPI 1154139640), doing business as Magnolia Body Renew, is a healthcare organization registered as a family in Gambrills, Maryland and active in the NPI registry since December 2024. The organization lists Shaquilla Vazquez Clark, Family Nurse Practitioner, as its authorized official.

NPPES Registry Identity

NPI1154139640
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameMAGNOLIA HEALTH CARE LLC
Location Address2407 BANEBERRY LNGambrills, MD 21054-1992
Mailing Address2407 Baneberry LnGambrills, MD 21054-1992 · (301) 715-3010 · Fax (410) 220-8162
Phone(301) 715-3010
Fax(410) 220-8162
Organization SubpartNo
Authorized OfficialShaquilla Vazquez ClarkFamily Nurse Practitioner · (301) 715-3010
Enumeration DateDecember 30, 2024
Last NPPES UpdateJanuary 2, 20262 updates tracked since enumeration
NPPES CertifiedJanuary 2, 2026
✔ NPI 1154139640 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
2407 BANEBERRY LN, Gambrills, MD 21054
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Other Names 2

Doing Business AsMagnolia Body Renew
Doing Business AsMagnolia Mobile Care

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MAGNOLIA HEALTH CARE LLC
Registered Nurse (Wound Care)
2407 BANEBERRY LN
GAMBRILLS, MD 21054
Anne Arundel County (410) 793-2634

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Magnolia Health Care LLC's NPI number?

The NPI number for Magnolia Health Care LLC is 1154139640. It was assigned to this organization in the NPPES registry on December 30, 2024. The provider is doing business as Magnolia Body Renew and Magnolia Mobile Care.

Where is Magnolia Health Care LLC located?

Magnolia Health Care LLC is located at 2407 Baneberry Ln, Gambrills, MD 21054. The listed phone number is (301) 715-3010.

What is Magnolia Health Care LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Magnolia Health Care LLC was last updated on January 2, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.