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General NPI Number Information
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NPI Number | 1114688801
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Entity Type | Individual
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Provider Name | HEATHER RENEE TENNYSON CRNP
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Gender | Female
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Dates
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Enumeration Date | 01/04/2022
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Last Update Date | 01/14/2022
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Provider Practice Location Address
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Address Line | 40900 MERCHANTS LN
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City | LEONARDTOWN
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State | MD
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Zip | 20650-3795
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Country | US
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Telephone | 301-690-2203
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Fax |
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Provider Business Mailing Address
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Address Line | 45041 DEAGLES BOATYARD RD
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City | TALL TIMBERS
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State | MD
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Zip | 20690-2050
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Country | US
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Telephone | 240-298-3589
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R177508
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F12210722
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License Number State | MD
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