Healthcare Provider Details

I. General information

NPI: 1639090368
Provider Name (Legal Business Name): PROFESSIONAL SKILLED HOME HEALTH CARE PROVIDERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3952 BRAVEHEART CIR
FREDERICK MD
21704-7743
US

IV. Provider business mailing address

3952 BRAVEHEART CIR
FREDERICK MD
21704-7743
US

V. Phone/Fax

Practice location:
  • Phone: 240-381-4648
  • Fax:
Mailing address:
  • Phone: 240-381-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: FLORA GEORGE TZAMBURAKIS
Title or Position: CEO
Credential: CRNP
Phone: 240-381-4648