Provider Demographics
NPI:1518724145
Name:TAJOCHA AMIN, CARINE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CARINE
Middle Name:
Last Name:TAJOCHA AMIN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6305 OGLETHORPE MILL DR
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-5693
Mailing Address - Country:US
Mailing Address - Phone:443-529-2074
Mailing Address - Fax:
Practice Address - Street 1:6305 OGLETHORPE MILL DR
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-5693
Practice Address - Country:US
Practice Address - Phone:443-529-2074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR230391163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse