DR. TINA BETTY EZEOLISAH DNP PMHNP-BC NPI 1306299268

NPI Information

NPI: 1306299268
Provider Name: DR. TINA BETTY EZEOLISAH, DNP, PMHNP-BC
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
3355 MCDANIEL RD
APT 17401
DULUTH, GA
ZIP 30096
Phone: (678) 704-3593
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DR. Tina Betty Ezeolisah, DNP, PMHNP-BC is a psychiatric/mental health nurse practitioner in Duluth, GA with 7 years of experience. DR. Tina Betty Ezeolisah, DNP, PMHNP-BC NPI is 1306299268. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: UNIVERSITY OF SOUTH ALABAMA COLLEGE OF MEDICINE
Graduation Year:2017

The provider's business location address is:

3355 MCDANIEL RD
APT 17401
DULUTH, GA
ZIP 30096-613
Phone: (678) 704-3593

The NPI 1306299268 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/15/2016 and was last updated on 12/2/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	RN2345725	MASSACHUSETTS	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	C-APN.0002066-C-NP	COLORADO	No
3	163W00000X	Registered Nurse		RN 217223	GEORGIA	No
4	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	05031	RHODE ISLAND	No
5	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	RN217223	GEORGIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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