Individual
TINA M AMIDEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
55 WHITCHER ST NE, SUITE 350, MARIETTA, GA 30060-1155
(770) 424-6893
(678) 819-0357
Mailing address
2198 WHITEHALL DR NE, MARIETTA, GA 30066-7200
(770) 424-6893
(618) 819-0357
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN147435
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
784964376B(MARIETTA)
—
GA
05
—
784964376C-WOODSTOCK
—
GA
05
—
784964376D(DOUGLAS)
—
GA
05
—
784964376E-HIRAM
—
GA
05
—
784964376F(AUSTELL)
—
GA
Enumeration date
03/20/2006
Last updated
06/11/2012
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