Healthcare Provider Details

I. General information

NPI: 1194649558
Provider Name (Legal Business Name): TINA OKOKONI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 OSLER DR
TOWSON MD
21204-7700
US

IV. Provider business mailing address

5 SPECTATOR LN
OWINGS MILLS MD
21117-4417
US

V. Phone/Fax

Practice location:
  • Phone: 410-227-1230
  • Fax:
Mailing address:
  • Phone: 443-657-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR255754
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: