Collaboration Agreement No:
4020
Confirmation No:
4020_1959C0006083
Section 1 - Physician Assistant Information
Confidential Information redacted.
Section 2 - Primary Practice Setting & Location:
Practice Type:
Nursing Home/Long Term Care Facility
Facility
Regency Care Of Silver Spring, Llc
Address
9101 Second Avenue
Silver Spring
MD 20910
Is this the location where a copy of your collaboration agreement is on file? NO
A copy (paper or electronic) must be immediately available upon request by the Board.
Location: 1205 York Rd Suite 11, Timonium, Maryland 21093
Section 3 - Advanced Duties and Prescriptive and Dispensing Authority
1.Does this Collaboration Agreement include Advanced Duties?
NO
2. Does this Collaboration Agreement include prescriptive authority?
YES
3. Does this Collaboration Agreement include dispensing authority under a physician's active dispensing permit?
NO