Provider Demographics
NPI:1558033092
Name:TUOPAEH, ROSELINE T (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:ROSELINE
Middle Name:T
Last Name:TUOPAEH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 PROFESSIONAL DR STE 450
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3370
Mailing Address - Country:US
Mailing Address - Phone:709-638-0307
Mailing Address - Fax:770-339-9577
Practice Address - Street 1:631 PROFESSIONAL DR STE 450
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3370
Practice Address - Country:US
Practice Address - Phone:709-638-0307
Practice Address - Fax:770-339-9577
Is Sole Proprietor?:No
Enumeration Date:2021-10-04
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN188767363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty