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General NPI Number Information
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NPI Number | 1033083753
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Entity Type | Individual
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Provider Name | TIA MOORE
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Gender | Female
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Dates
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Enumeration Date | 10/04/2025
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Last Update Date | 10/04/2025
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Provider Practice Location Address
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Address Line | 6100 E MAIN ST STE 110
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City | COLUMBUS
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State | OH
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Zip | 43213-3399
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Country | US
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Telephone | 614-861-1120
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Fax |
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Provider Business Mailing Address
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Address Line | 10535 TOLLGATE RD SW
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City | ETNA
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State | OH
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Zip | 43062-8324
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Country | US
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Telephone | 614-636-9987
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | APRN.CNP.0040480
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License Number State | OH
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