Provider Demographics
NPI:1467165134
Name:TITA, ELIZABETH NGWE-NINGOH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NGWE-NINGOH
Last Name:TITA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 HUNT CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-1707
Mailing Address - Country:US
Mailing Address - Phone:727-637-5880
Mailing Address - Fax:
Practice Address - Street 1:3333 HUNT CLUB DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-1707
Practice Address - Country:US
Practice Address - Phone:727-637-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023280363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health