Provider Demographics
NPI:1346742335
Name:TAH EPSE TITA, ERNESTINE A
Entity type:Individual
Prefix:
First Name:ERNESTINE
Middle Name:A
Last Name:TAH EPSE TITA
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 1:9787 GOOD LUCK RD APT 12
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3342
Mailing Address - Country:US
Mailing Address - Phone:240-396-7584
Mailing Address - Fax:
Practice Address - Street 1:9787 GOOD LUCK RD APT 12
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3342
Practice Address - Country:US
Practice Address - Phone:240-396-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-06
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA13523374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide