Healthcare Provider Details

I. General information

NPI: 1801772447
Provider Name (Legal Business Name): TIDAL RHYTHM WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAIN ST UNIT 202
BERLIN CT
06037-2661
US

IV. Provider business mailing address

10 MAIN ST UNIT 202
BERLIN CT
06037-2661
US

V. Phone/Fax

Practice location:
  • Phone: 860-463-2964
  • Fax:
Mailing address:
  • Phone: 860-463-2964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STACY CHRISTENSEN
Title or Position: OWNER
Credential: APRN
Phone: 860-463-2964