Provider Demographics
NPI:1811561988
Name:THULL, TESSA
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:THULL
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 1:3219 CLIFTON AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-3047
Mailing Address - Country:US
Mailing Address - Phone:513-346-1270
Mailing Address - Fax:513-346-1270
Practice Address - Street 1:3219 CLIFTON AVE STE 305
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-3047
Practice Address - Country:US
Practice Address - Phone:513-346-1270
Practice Address - Fax:513-346-1281
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.008281RX363A00000X
NVPA2719364SP0809X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program