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General NPI Number Information
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NPI Number | 1619010154
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Entity Type | Individual
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Provider Name | TINA MUMBI MBATIA CRNP-FAMILY
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 50 W EDMONSTON DR STE 502
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City | ROCKVILLE
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State | MD
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Zip | 20852-1222
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Country | US
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Telephone | 301-637-3005
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Fax |
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Provider Business Mailing Address
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Address Line | 13209 OSTERPORT DR
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City | SILVER SPRING
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State | MD
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Zip | 20906-5912
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Country | US
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Telephone | 301-717-3554
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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 | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | R163339
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R163339
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License Number State | MD
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