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General NPI Number Information
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NPI Number | 1982279253
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Entity Type | Organization
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Legal Business Name | SERENITY HEART HEALTHCARE, LLC
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Dates
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Enumeration Date | 05/20/2021
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Last Update Date | 05/20/2021
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Provider Practice Location Address
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Address Line | 6755 BUSINESS PKWY STE 304
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City | ELKRIDGE
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State | MD
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Zip | 21075-6740
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Country | US
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Telephone | 410-299-4603
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Fax | 443-308-0916
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Provider Business Mailing Address
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Address Line | 6755 BUSINESS PKWY STE 304
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City | ELKRIDGE
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State | MD
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Zip | 21075-6740
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Country | US
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Telephone | 410-299-4603
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Fax | 443-308-0916
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MICHELLE A TUCKER-JONES
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Credential | PMHNP-BC, FNP-BC
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Telephone | 410-216-0268
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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