Provider Demographics
NPI:1568754604
Name:TATINENI, KAVITHA (NP)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:TATINENI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 KINGSLEY LANE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23505
Mailing Address - Country:US
Mailing Address - Phone:757-354-2885
Mailing Address - Fax:757-889-5742
Practice Address - Street 1:110 KINGSLEY LN
Practice Address - Street 2:SUITE 106
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4614
Practice Address - Country:US
Practice Address - Phone:757-354-2885
Practice Address - Fax:757-889-5742
Is Sole Proprietor?:No
Enumeration Date:2011-05-09
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169300363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner