Healthcare Provider Details

I. General information

NPI: 1245156520
Provider Name (Legal Business Name): TINA KHAINJIRI ZEISIG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 BAYMOUTH LN
RALEIGH NC
27610-8030
US

IV. Provider business mailing address

508 FULTON ST
DURHAM NC
27705-3875
US

V. Phone/Fax

Practice location:
  • Phone: 269-254-4896
  • Fax:
Mailing address:
  • Phone: 919-286-0411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number298113
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: