Healthcare Provider Details

I. General information

NPI: 1346636420
Provider Name (Legal Business Name): AMY LINDEN CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY TANNENBAUM

II. Dates (important events)

Enumeration Date: 04/15/2015
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVENUE JOHNS HOPKINS ELDER PLUS - PACE
BALTIMORE MD
21224
US

IV. Provider business mailing address

4940 EASTERN AVENUE JOHNS HOPKINS ELDER PLUS-PACE
BALTIMORE MD
21224
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-8093
  • Fax:
Mailing address:
  • Phone: 410-550-8093
  • Fax: 410-933-1390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberR196183
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR196183
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberR196183
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: