Healthcare Provider Details

I. General information

NPI: 1578467064
Provider Name (Legal Business Name): AKIBBA CHANTYE DAVIS-TINGLING LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WILKENS AVE
BALTIMORE MD
21229-5213
US

IV. Provider business mailing address

3455 WILKENS AVE
BALTIMORE MD
21229-5213
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-6970
  • Fax: 410-644-5609
Mailing address:
  • Phone: 410-646-6970
  • Fax: 410-644-5609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5172199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: