Provider Demographics
NPI:1386637098
Name:TINDONG, NICHOLAS E (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:E
Last Name:TINDONG
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 CELESTE BRUCE CIR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2287
Mailing Address - Country:US
Mailing Address - Phone:240-260-3827
Mailing Address - Fax:240-260-3830
Practice Address - Street 1:7404 EXECUTIVE PL STE 100
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6237
Practice Address - Country:US
Practice Address - Phone:240-260-3827
Practice Address - Fax:240-260-3830
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN305565163W00000X
MDR180878363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse