Provider Demographics
NPI:1205134210
Name:JATTA, EBRIMA (RN)
Entity type:Individual
Prefix:
First Name:EBRIMA
Middle Name:
Last Name:JATTA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43203-1779
Mailing Address - Country:US
Mailing Address - Phone:614-257-2730
Mailing Address - Fax:
Practice Address - Street 1:5128 STONE RIDGE RD S
Practice Address - Street 2:APT B
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4141
Practice Address - Country:US
Practice Address - Phone:614-353-4403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029261363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health