Provider Demographics
NPI:1619010154
Name:MBATIA, TINA MUMBI (CRNP-FAMILY)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MUMBI
Last Name:MBATIA
Suffix:
Gender:F
Credentials:CRNP-FAMILY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13209 OSTERPORT DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-5912
Mailing Address - Country:US
Mailing Address - Phone:301-717-3554
Mailing Address - Fax:
Practice Address - Street 1:50 W EDMONSTON DR STE 502
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1222
Practice Address - Country:US
Practice Address - Phone:301-637-3005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR163339163WC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine