Healthcare Provider Details

I. General information

NPI: 1316756943
Provider Name (Legal Business Name): HEART AND SOUL FAMILY HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2025
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8508 LOCH RAVEN BLVD STE B
TOWSON MD
21286-2354
US

IV. Provider business mailing address

151 W RING FACTORY RD
BEL AIR MD
21014-5303
US

V. Phone/Fax

Practice location:
  • Phone: 443-876-6692
  • Fax:
Mailing address:
  • Phone: 443-876-6692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICE BULLOCK
Title or Position: NP/OWNER
Credential: NP
Phone: 443-876-6692