Provider Demographics
NPI:1255980728
Name:PITTS, TIARA CHRISTINE
Entity type:Individual
Prefix:
First Name:TIARA
Middle Name:CHRISTINE
Last Name:PITTS
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 1:6902 MOUNTAIN LAKE PL
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-4611
Mailing Address - Country:US
Mailing Address - Phone:301-351-6506
Mailing Address - Fax:
Practice Address - Street 1:6196 OXON HILL RD STE 610
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3112
Practice Address - Country:US
Practice Address - Phone:301-669-1870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR194246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily