Healthcare Provider Details

I. General information

NPI: 1316867153
Provider Name (Legal Business Name): TIDAL POINT WELLNESS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FOREST LN
EAST GREENWICH RI
02818-1015
US

IV. Provider business mailing address

15 FOREST LN
EAST GREENWICH RI
02818-1015
US

V. Phone/Fax

Practice location:
  • Phone: 401-215-6796
  • Fax:
Mailing address:
  • Phone: 401-215-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: REBECCA BURDI
Title or Position: OWNER
Credential: PMHNP
Phone: 401-215-6796