Provider Demographics
NPI:1003437377
Name:TANGI, JUDITH (CRNP-PMH)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:TANGI
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8125 MALLARD SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-2967
Mailing Address - Country:US
Mailing Address - Phone:240-838-4012
Mailing Address - Fax:
Practice Address - Street 1:8125 MALLARD SHORE DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-2967
Practice Address - Country:US
Practice Address - Phone:240-838-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-28
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184959363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health