Healthcare Provider Details

I. General information

NPI: 1922865625
Provider Name (Legal Business Name): TENIA BRAGG PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 KINROSS LAKES PKWY
RICHFIELD OH
44286-9010
US

IV. Provider business mailing address

17087 HUNTING MEADOWS DR
STRONGSVILLE OH
44136-6226
US

V. Phone/Fax

Practice location:
  • Phone: 855-259-9183
  • Fax:
Mailing address:
  • Phone: 440-623-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.400969
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0034584
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: