Provider Demographics
NPI:1285693234
Name:AMIDEI, TINA M (ACNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:AMIDEI
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
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Mailing Address - Street 1:2198 WHITEHALL DR NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-7200
Mailing Address - Country:US
Mailing Address - Phone:770-424-6893
Mailing Address - Fax:618-819-0357
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 350
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-424-6893
Practice Address - Fax:678-819-0357
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2012-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN147435363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA784964376B(MARIETTA)Medicaid
GA784964376E-HIRAMMedicaid
GA784964376D(DOUGLAS)Medicaid
GA784964376C-WOODSTOCKMedicaid
GA784964376F(AUSTELL)Medicaid
GA784964376C-WOODSTOCKMedicaid
GA784964376B(MARIETTA)Medicaid