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

Q: 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.

Q: 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.

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: November 08, 2026.

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

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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

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Magnolia Health Care Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 2 clinicians reassign Medicare billing to Magnolia Health Care LLC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (2)

Shaquilla Vazquez Clark, DNP CRNP FNP-BC FNPC

Nurse Practitioner

NPI 1538869789

11166 FAIRFAX BLVD STE 500
Fairfax, VA 22030

(301) 715-3010

✔ PECOS✔ Accepts Medicare37 mi

Miltonia Bell

Nurse Practitioner

NPI 1417631003

8401 MAYLAND DR STE A
Richmond, VA 23294

(703) 452-5525

✔ PECOS✔ Accepts Medicare109 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

Is Magnolia Health Care LLC enrolled in Medicare?

Yes. Magnolia Health Care LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Magnolia Health Care LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Magnolia Health Care LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 10 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.