Provider Demographics
NPI:1659632073
Name:ETEA, TIGIST
Entity Type:Individual
Prefix:
First Name:TIGIST
Middle Name:
Last Name:ETEA
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 1:2004 RHODE ISLAND AVE NE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2835
Mailing Address - Country:US
Mailing Address - Phone:202-558-6084
Mailing Address - Fax:
Practice Address - Street 1:8025 13TH ST APT 348
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-5819
Practice Address - Country:US
Practice Address - Phone:571-315-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide