Provider Demographics
NPI:1922865625
Name:BRAGG, TENIA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:TENIA
Middle Name:
Last Name:BRAGG
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17087 HUNTING MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-6226
Mailing Address - Country:US
Mailing Address - Phone:440-623-5512
Mailing Address - Fax:
Practice Address - Street 1:4199 KINROSS LAKES PKWY
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9010
Practice Address - Country:US
Practice Address - Phone:855-259-9183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.400969163W00000X
OHAPRN.CNP.0034584363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse