Healthcare Provider Details

I. General information

NPI: 1639691447
Provider Name (Legal Business Name): TENICIA S WASHINGTON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2017
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 N POINT BLVD STE 321
BALTIMORE MD
21224-3472
US

IV. Provider business mailing address

1105 N POINT BLVD STE 321
BALTIMORE MD
21224-3472
US

V. Phone/Fax

Practice location:
  • Phone: 410-517-7060
  • Fax: 443-407-2942
Mailing address:
  • Phone: 410-517-7060
  • Fax: 443-407-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR197069
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR197069
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: