Healthcare Provider Details

I. General information

NPI: 1619805587
Provider Name (Legal Business Name): TEAMEKA NICOLE BRADLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5603 SPRUCE DR
CLINTON MD
20735-1453
US

IV. Provider business mailing address

5603 SPRUCE DR
CLINTON MD
20735-1453
US

V. Phone/Fax

Practice location:
  • Phone: 202-740-3018
  • Fax: 202-740-3018
Mailing address:
  • Phone: 202-740-3018
  • Fax: 202-740-3018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024197939
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR227335
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: