Provider Demographics
NPI:1487070868
Name:HAMILTON, TYWANNA (CRNP)
Entity type:Individual
Prefix:
First Name:TYWANNA
Middle Name:
Last Name:HAMILTON
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 1:124 SLADE AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4900
Mailing Address - Country:US
Mailing Address - Phone:410-729-5100
Mailing Address - Fax:
Practice Address - Street 1:7556 TEAGUE RD STE 210
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076
Practice Address - Country:US
Practice Address - Phone:410-551-0499
Practice Address - Fax:410-799-9070
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX709999363LF0000X
MDR245831363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily