Support Care LLC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

SUPPORT CARE LLC

Practice address

5609 Pine Bluff CT
Frederick, MD 21704-6894

Phone

(240) 765-5159

NPI assigned

Dec 29, 2025

Organization subpart

No

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

Authorized official

Name

Mrs. Renie Efuetngu Leke Tazisong, PMHNP-BCNPI 1629727730

Title

Pmhnp-PMH

Phone

(240) 765-5159

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Renie Efuetngu Leke Tazisong, PMHNP-BC

  • Psychiatric/Mental Health Registered Nurse
  • Columbia, MD
  • NPI 1629727730
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1766966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766966400000",
    "number": "1841156494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5609 PINE BLUFF CT",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217046894",
            "telephone_number": "240-765-5159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5609 PINE BLUFF CT",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217046894",
            "telephone_number": "240-765-5159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPPORT CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-29",
        "last_updated": "2025-12-29",
        "certification_date": "2025-12-28",
        "status": "A",
        "authorized_official_last_name": "TAZISONG",
        "authorized_official_first_name": "RENIE",
        "authorized_official_middle_name": "EFUETNGU LEKE",
        "authorized_official_title_or_position": "PMHNP-PMH",
        "authorized_official_telephone_number": "240-765-5159",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychiatric/Mental Health Nurse Practitioner in Frederick, MD
• Providers in Frederick, MD by specialty
• Psychiatric/Mental Health Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.