Healthcare Provider Details

I. General information

NPI: 1386637098
Provider Name (Legal Business Name): NICHOLAS E TINDONG PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2005
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 EXECUTIVE PL STE 100
LANHAM MD
20706-6237
US

IV. Provider business mailing address

3613 CELESTE BRUCE CIR
BOWIE MD
20721-2287
US

V. Phone/Fax

Practice location:
  • Phone: 240-260-3827
  • Fax: 240-260-3830
Mailing address:
  • Phone: 240-260-3827
  • Fax: 240-260-3830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR180878
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN305565
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: