Provider Demographics
NPI:1083318141
Name:GIRMA, TIZITA Z (RN)
Entity Type:Individual
Prefix:MRS
First Name:TIZITA
Middle Name:Z
Last Name:GIRMA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12806 MY MOLLIES PRIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5618
Mailing Address - Country:US
Mailing Address - Phone:301-332-6538
Mailing Address - Fax:
Practice Address - Street 1:12806 MY MOLLIES PRIDE DR.
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-2072
Practice Address - Country:US
Practice Address - Phone:301-332-6538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR175105163WD1100X, 163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WD1100XNursing Service ProvidersRegistered NurseDialysis, Peritoneal