Provider Demographics
NPI:1811223340
Name:TULGA, DENISE STAGE (CNNP - BC)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:STAGE
Last Name:TULGA
Suffix:
Gender:F
Credentials:CNNP - BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 FAWNBROOK CT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-8115
Mailing Address - Country:US
Mailing Address - Phone:614-861-0469
Mailing Address - Fax:
Practice Address - Street 1:1710 FAWNBROOK CT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-8115
Practice Address - Country:US
Practice Address - Phone:614-861-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-17
Last Update Date:2009-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH155537363LN0000X
OH98441363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2398838Medicaid