Provider Demographics
NPI:1386361996
Name:BRADY, TINA ANN (AGPCNP-C)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:BRADY
Suffix:
Gender:F
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 THREE SISTERS CT
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:MD
Mailing Address - Zip Code:21013-9792
Mailing Address - Country:US
Mailing Address - Phone:443-465-2092
Mailing Address - Fax:
Practice Address - Street 1:9 THREE SISTERS CT
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:MD
Practice Address - Zip Code:21013-9792
Practice Address - Country:US
Practice Address - Phone:443-465-2092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022653363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health