Provider Demographics
NPI:1386003986
Name:NTULI, THANDEKA THELMA (MSN, APRN, AGNP-C)
Entity Type:Individual
Prefix:
First Name:THANDEKA
Middle Name:THELMA
Last Name:NTULI
Suffix:
Gender:F
Credentials:MSN, APRN, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 HURRICANE SHOALS ROAD N.W.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8762
Mailing Address - Country:US
Mailing Address - Phone:404-645-7150
Mailing Address - Fax:770-339-4797
Practice Address - Street 1:595 HURRICANE SHOALS ROAD N.W.
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8762
Practice Address - Country:US
Practice Address - Phone:404-645-7150
Practice Address - Fax:770-339-4797
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-11
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN17400363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily