MRS. TINA BETTY EZEOLISAH (NPI# 1306299268) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306299268 |
| Entity Type | Individual |
| Full Name | MRS. TINA BETTY EZEOLISAH |
| Credential | DNP, PMHNP-BC |
| Practice Address |
3355 Mcdaniel Rd Apt 17401 Duluth GA 30096-8613 |
| Practice Telephone | 6787043593 |
| Mailing Telephone | 6787043593 |
| Enumeration Date | 2016-07-15 |
| Last Update Date | 2019-07-10 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN 217223 | GA | Nursing Service Providers |
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
APNP 217223 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1814 Clairmont Rd, Decatur, GA 300333405 | 4046361457 | 4046367449 |
| 940 Concord Rd Se, Smyrna, GA 300804204 | 4046361457 | 4046367449 |
| Street Address |
3355 MCDANIEL RD APT 17401 |
| City | DULUTH |
| State | GA |
| Zip Code | 30096-8613 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326581810 | Angela Christian | Counselor | 3355 Mcdaniel Rd, Apt 10203, Duluth, GA 30096-8613 | 2016-12-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922615897 | Georgia Eye Optical, LLC | Ophthalmology | 3800 Pleasant Hill Rd Ste 3, Duluth, GA 30096 | 2020-09-25 |
| 1568090868 | Positive Behavior Services, Inc | Behavior Technician | 3765 Crestwood Pkwy Nw, Duluth, GA 30096 | 2020-03-31 |
| 1861031940 | Elizabeth Ashley Edouard | Counselor | 3464 Duluth Hwy 120, Duluth, GA 30096 | 2020-01-06 |
| 1245701044 | Kathryn Irene Vaughn | Social Worker | 3968 Mainsail Court, Duluth, GA 30096 | 2018-12-06 |
| 1083184626 | Aica Orthopedics, P.C. | Orthopaedic Surgery | 3775 Venture Drive Bldg F, Duluth, GA 30096 | 2018-11-27 |
| 1245709799 | Positive Impact Health Centers, Inc. | Pharmacy | 3350 Breckinridge Blvd, Suite 200a, Duluth, GA 30096 | 2018-11-14 |
| 1235611724 | Katherine Winstead Knott | Counselor | 3460 Summit Ridge Parkway, Suite 503, Duluth, GA 30096 | 2018-08-31 |
| 1710467857 | Envision Optics LLC | Optometrist | 1943 Pleasant Hill Rd, Duluth, GA 30096 | 2018-08-17 |
| 1104314202 | Erin Mckernan Scupham | Chiropractor | 3820 Pleasant Hill Rd. Ne, Suite 4, Duluth, GA 30096 | 2018-04-25 |
| 1053839456 | Rogers Bridge Pediatric Therapy, LLC | Clinic/Center | 2845 Summercrest Ln, Duluth, GA 30096 | 2017-09-06 |
| Find all providers in zip 30096 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831737501 | Farah Rahim | Nurse Practitioner | 3305 Breckinridge Blvd, Duluth, GA 30096-4932 | 2019-12-12 |
| 1699311787 | Sharon Mclean | Nurse Practitioner | 3843 Meeting St, Duluth, GA 30096-4816 | 2019-11-23 |
| 1710505680 | Sarah Mcisaac | Nurse Practitioner | 925 E Superior St Ste 113, Duluth, MN 55802-2253 | 2020-07-08 |
| 1780201657 | Alyssa Dye | Nurse Practitioner | 615 Pecan Ave, Duluth, MN 55811-2749 | 2020-06-26 |
| 1386260370 | Heidi A Greifzu | Nurse Practitioner | 502 E 2nd St, Duluth, MN 55805-1913 | 2020-06-25 |
| 1528684446 | Heidi Louise Wendorf | Nurse Practitioner | 1406 E 2nd St, Duluth, MN 55805-2378 | 2020-06-17 |
| 1134772072 | Jessica Marie Johnson | Nurse Practitioner | 220 N 6th Ave E, Duluth, MN 55805 | 2019-07-19 |
| 1003468760 | Molly B Dwyer | Nurse Practitioner | 400 E 3rd St, Duluth, MN 55805-1951 | 2019-07-12 |
| 1013493345 | Amy Jo Schwab | Nurse Practitioner | 332 W Superior St Ste 300, Duluth, MN 55802-1844 | 2018-07-19 |
| 1396237764 | Coleen Rose Christensen | Nurse Practitioner | 332 W Superior St Ste 300, Duluth, MN 55802-1844 | 2018-06-01 |
| Find all providers in DULUTH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.