Healthcare Provider Details

I. General information

NPI: 1013759661
Provider Name (Legal Business Name): TIDAL WAVE PSYCHIATRIC WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 ROUTE 47 N
CAPE MAY COURT HOUSE NJ
08210-1321
US

IV. Provider business mailing address

631 ROUTE 47 N
CAPE MAY COURT HOUSE NJ
08210-1321
US

V. Phone/Fax

Practice location:
  • Phone: 609-675-3630
  • Fax:
Mailing address:
  • Phone: 609-675-3630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. TRACEY ANGEL NAGLE
Title or Position: OWNER/PSYCH NP
Credential: DNP, APN
Phone: 609-675-3630