Healthcare Provider Details

I. General information

NPI: 1063389864
Provider Name (Legal Business Name): SUMMER BREEZE MENOPAUSE & HORMONE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 FAWN WAY
FINKSBURG MD
21048-2020
US

IV. Provider business mailing address

1815 FAWN WAY
FINKSBURG MD
21048-2020
US

V. Phone/Fax

Practice location:
  • Phone: 443-205-6356
  • Fax:
Mailing address:
  • Phone: 443-205-6356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SUMMER MCKISSICK
Title or Position: NURSE PRACTITIONER
Credential: MSN, CRNP, A-GNP-C
Phone: 443-205-6356