Healthcare Provider Details

I. General information

NPI: 1336194760
Provider Name (Legal Business Name): TIANNA TSITSIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TIANNA EITNER MD

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 05/06/2022
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E GEORGE HOPPER RD STE 101
BURLINGTON WA
98233-3154
US

IV. Provider business mailing address

325 E GEORGE HOPPER RD STE 101
BURLINGTON WA
98233-3154
US

V. Phone/Fax

Practice location:
  • Phone: 360-982-2620
  • Fax:
Mailing address:
  • Phone: 360-982-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD00036193
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00036193
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: