Healthcare Provider Details

I. General information

NPI: 1376244285
Provider Name (Legal Business Name): TINA BONGNWI NGATOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 MLK JR AVE SW
WASHINGTON DC
20032-4933
US

IV. Provider business mailing address

13920 CASTLE BLVD APT 310
SILVER SPRING MD
20904-4958
US

V. Phone/Fax

Practice location:
  • Phone: 202-318-0179
  • Fax:
Mailing address:
  • Phone: 301-256-7581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number500339469
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: