Healthcare Provider Details

I. General information

NPI: 1154945368
Provider Name (Legal Business Name): MARK TUVELLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2020
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 E BROAD ST
COLUMBUS OH
43213-1156
US

IV. Provider business mailing address

6400 E BROAD ST FL 4
COLUMBUS OH
43213-2086
US

V. Phone/Fax

Practice location:
  • Phone: 614-350-1970
  • Fax:
Mailing address:
  • Phone: 614-655-3345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN.CNP.0027445
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License NumberRN.395783
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: