Provider Demographics
NPI:1619443793
Name:JEAN-PIERRE, TIYIA LE'TWAN
Entity Type:Individual
Prefix:MRS
First Name:TIYIA
Middle Name:LE'TWAN
Last Name:JEAN-PIERRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TIYIA
Other - Middle Name:LE'TWAN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:4480 KING ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-1339
Mailing Address - Country:US
Mailing Address - Phone:703-746-4949
Mailing Address - Fax:
Practice Address - Street 1:4480 KING ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-1339
Practice Address - Country:US
Practice Address - Phone:703-746-4949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily