MEDICARE: OPTIMAL HEALTH AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1346925054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OPTIMAL HEALTH AND WELLNESS

Provider Business Mailing Address
First Line	:	178 N MECHANIC ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2316
Country	:	US
Telephone Number	:	240-580-6397
Fax Number	:

Provider Business Practice Location Address
First Line	:	178 N MECHANIC ST
Second Line	:
City	:	CUMBERLAND
State	:	MD
Zip	:	21502-2316
Country	:	US
Telephone Number	:	240-580-6397
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	TAMMY COLLETTE
Credential	:	CRNP
Telephone Number	:	240-580-6397

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	06/20/2023

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Directions to “OPTIMAL HEALTH AND WELLNESS ” Practice Location

Language	Start Address	Practice Location

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