Tina Walde, DNP, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

12.008564 Issued in CT

Practice address

264 Church St
Guilford, CT 06437-2439

Phone

(509) 834-9213

NPI assigned

Sep 12, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Wellness Place

  • Psychiatric/Mental Health Nurse Practitioner
  • Madison, CT
  • NPI 1801467105
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611187200000",
    "number": "1124277223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 CHURCH ST",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372439",
            "telephone_number": "509-834-9213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 CHURCH ST",
            "city": "GUILFORD",
            "state": "CT",
            "postal_code": "064372439",
            "telephone_number": "509-834-9213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDE",
        "first_name": "TINA",
        "name_prefix": "Ms.",
        "credential": "DNP, PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-12",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "10.081826",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CT",
            "license": "12.008564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Visiting Nurse Association Community Healthcare Inc
• Visiting Nurse Association Community Healthcare, Inc
• Visualeyes, LLC
• Visualeyes,LLC
• Lauren Voelker
• Walgreen Co
• James M. Waller, DPT
• Qiaoqiao Wang, PH.D., O.D.
• Ashley Warner, LCSW
• Megan Beth Warner, PH.D.

• Psychiatric/Mental Health Nurse Practitioner in Guilford, CT
• Providers in Guilford, CT by specialty
• Psychiatric/Mental Health Nurse Practitioner in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.