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General NPI Number Information
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NPI Number | 1922865625
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Entity Type | Individual
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Provider Name | TENIA BRAGG PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 02/29/2024
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Provider Practice Location Address
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Address Line | 4199 KINROSS LAKES PKWY
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City | RICHFIELD
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State | OH
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Zip | 44286-9010
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Country | US
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Telephone | 855-259-9183
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Fax |
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Provider Business Mailing Address
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Address Line | 17087 HUNTING MEADOWS DR
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City | STRONGSVILLE
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State | OH
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Zip | 44136-6226
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Country | US
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Telephone | 440-623-5512
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN.400969
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN.CNP.0034584
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License Number State | OH
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