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General NPI Number Information
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NPI Number | 1790414266
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Entity Type | Individual
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Provider Name | TINA DENNELL BRACY NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 06/08/2022
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Last Update Date | 06/08/2022
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Provider Practice Location Address
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Address Line | 3821 TIMBER VIEW WAY
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City | REISTERSTOWN
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State | MD
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Zip | 21136-1839
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Country | US
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Telephone | 410-654-2442
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Fax |
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Provider Business Mailing Address
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Address Line | 3821 TIMBER VIEW WAY
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City | REISTERSTOWN
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State | MD
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Zip | 21136-1839
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Country | US
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Telephone | 443-900-6897
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | R187132
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License Number State | MD
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