Provider Demographics
NPI:1316377377
Name:BRANDFORD, TRIDONNA DEVAL (CRNP)
Entity Type:Individual
Prefix:
First Name:TRIDONNA
Middle Name:DEVAL
Last Name:BRANDFORD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 OLD COURT RD STE 4A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3901
Mailing Address - Country:US
Mailing Address - Phone:443-898-6622
Mailing Address - Fax:866-319-9336
Practice Address - Street 1:7 MINK HOLLOW CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4868
Practice Address - Country:US
Practice Address - Phone:410-654-8610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122316363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily