Healthcare Provider Details

I. General information

NPI: 1720710171
Provider Name (Legal Business Name): SBB FIT 4 LIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2022
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4709 HARFORD RD
BALTIMORE MD
21214-3205
US

IV. Provider business mailing address

4709 HARFORD RD
BALTIMORE MD
21214-3205
US

V. Phone/Fax

Practice location:
  • Phone: 443-470-9142
  • Fax:
Mailing address:
  • Phone: 443-470-9142
  • Fax: 410-735-5702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JUDI D BROWN BROWN
Title or Position: FAMILY NURSE PRACTITIONER
Credential: CRNP
Phone: 443-470-9142