Healthcare Provider Details

I. General information

NPI: 1508760679
Provider Name (Legal Business Name): HEALIQUE HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 COLD SPRING WAY APT 334
CROFTON MD
21114-2864
US

IV. Provider business mailing address

2910 COLD SPRING WAY APT 334
CROFTON MD
21114-2864
US

V. Phone/Fax

Practice location:
  • Phone: 301-747-1218
  • Fax:
Mailing address:
  • Phone: 301-747-1218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMARA GANT
Title or Position: OWNER
Credential: CRNP
Phone: 813-731-9771