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General NPI Number Information
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NPI Number | 1083320899
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Entity Type | Organization
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Legal Business Name | BRIDGES TO WELLNESS CENTRE LLC
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Dates
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Enumeration Date | 01/25/2023
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Last Update Date | 12/21/2023
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Provider Practice Location Address
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Address Line | 12522 GREAT PARK CIR APT 303
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City | GERMANTOWN
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State | MD
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Zip | 20876-5985
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Country | US
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Telephone | 848-220-6659
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2718
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City | GERMANTOWN
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State | MD
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Zip | 20875-2718
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Country | US
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Telephone | 848-220-6659
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | TAMMY L COOPER
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Credential | CRNP
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Telephone | 848-220-6659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 405300000X
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Taxonomy Name | Prevention Professional
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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