Provider Demographics
NPI:1720767072
Name:JETHA, TULSI (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:TULSI
Middle Name:
Last Name:JETHA
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 CIRCLE 75 PKWY SE APT 2107
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-4286
Mailing Address - Country:US
Mailing Address - Phone:229-894-5563
Mailing Address - Fax:
Practice Address - Street 1:4501 CIRCLE 75 PKWY SE APT 2107
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-4286
Practice Address - Country:US
Practice Address - Phone:229-894-5563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN282021363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily