Provider Demographics
NPI:1063777043
Name:TUSA, ANASTASIA LEIGH (CRNP-PMH)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:LEIGH
Last Name:TUSA
Suffix:
Gender:F
Credentials:CRNP-PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 OCEAN GTWY
Mailing Address - Street 2:# 4
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7217
Mailing Address - Country:US
Mailing Address - Phone:410-749-1015
Mailing Address - Fax:410-749-0654
Practice Address - Street 1:8614 OCEAN GTWY
Practice Address - Street 2:STE 4
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7217
Practice Address - Country:US
Practice Address - Phone:410-690-8181
Practice Address - Fax:410-690-8185
Is Sole Proprietor?:No
Enumeration Date:2012-07-06
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR187655363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
S118Medicare UPIN
211862Medicare Oscar/Certification