Healthcare Provider Details

I. General information

NPI: 1316873789
Provider Name (Legal Business Name): DYNAMIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

IV. Provider business mailing address

3261 OLD WASHINGTON RD STE 2020
WALDORF MD
20602-3231
US

V. Phone/Fax

Practice location:
  • Phone: 301-266-9114
  • Fax: 301-932-9027
Mailing address:
  • Phone: 301-266-9114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE ALEXANDRA GRIFFIN
Title or Position: DNP
Credential: CRNP
Phone: 301-266-9114