NINO KAVTARADZE (NPI# 1639574841) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639574841 |
| Entity Type | Individual |
| Full Name | NINO KAVTARADZE |
| Credential | CRNP |
| Practice Address |
1200 Bustleton Pike Ste 16a3 Feasterville Trevose PA 19053-4118 |
| Practice Telephone | 2675745236 |
| Mailing Telephone | 2672237738 |
| Mailing Fax Number | 2672237738 |
| Enumeration Date | 2014-10-30 |
| Last Update Date | 2020-01-29 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN632493 | PA | Nursing Service Providers |
| Y | 363L00000X | Nurse Practitioner | SP015632 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
SP015632 | PA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1032670520017 | 05 | |
| PA | PENNSYLVANIA DEPARTMENT OF STATE | RN632493 | 01 |
| AMERICAN NURSES CREDENTIALING CENTER (ANCC) | 33402683 | 01 | |
| PA | PENNSYLVANIA DEPARTMENT OF STATE | SP015632 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 11043 Greiner Rd, Philadelphia, PA 191162611 | 2675745236 |
| Street Address |
1200 BUSTLETON PIKE STE 16A3 |
| City | FEASTERVILLE TREVOSE |
| State | PA |
| Zip Code | 19053-4118 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497316996 | Practitioner LLC | Nurse Practitioner | 1200 Bustleton Pike Ste 16a3, Feasterville Trevose, PA 19053-4118 | 2019-06-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710451539 | For Eyes Optical of Pa | Optometrist | 186 West Street Road, Feasterville, PA 19053 | 2019-01-15 |
| 1881181410 | Linda S Linden | Massage Therapist | 333 Steele Rd, Feasterville, PA 19053 | 2018-04-19 |
| 1336671619 | Marsela Ismailanji | Behavioral Analyst | 4 Neshaminy Interplex Drive, Suite 202, Trevose, PA 19053 | 2017-03-28 |
| 1194189019 | Kathleen A Gant | Nurse Practitioner | 4829 Street Rd, Trevose, PA 19053 | 2016-04-06 |
| 1801263165 | Kristi Ann Wert | Nurse Practitioner | 4829 E. Street Rd, Trevose, PA 19053 | 2015-08-21 |
| 1841675113 | Marlene Lisa Levis | Pharmacist | 176 West Street Road, Feasterville, PA 19053 | 2015-07-28 |
| 1578802229 | Colleen Joan Garneau | Registered Nurse | 2500 N Gate Rd, Trevose, PA 19053 | 2013-01-31 |
| 1225306376 | Michael J Fanelli | Pharmacist | 2 E. Street Rd, Feasterville, PA 19053 | 2011-12-05 |
| 1053689125 | Yuliya Peskin | Pharmacist | 2 E Street Road, Walgreens, Feasterville, PA 19053 | 2011-12-05 |
| 1891000584 | Justin T Jiunta | Physical Therapist | 1040 Mill Creek Drive, Feasterville, PA 19053 | 2010-08-18 |
| Find all providers in zip 19053 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326648320 | Jennifer Glace | Nurse Practitioner | 5 Moore Cir, Media, PA 19063-4953 | 2020-10-28 |
| 1710586805 | Tracey Wuestkamp Sloan | Nurse Practitioner | 5218 Bailey Ct W, Doylestown, PA 18902-1477 | 2020-10-20 |
| 1477151280 | Kelly M. Distelrath | Nurse Practitioner | 4203 Timberlane Dr, Allison Park, PA 15101-2954 | 2020-10-14 |
| 1538766837 | Kimberly Ann Martyn | Nurse Practitioner | 168 W Baltimore Pike, Media, PA 19063 | 2020-10-08 |
| 1679170989 | Aubree Marie Richards | Nurse Practitioner | 253 N Hershey Rd Ste 2, Harrisburg, PA 17112-9752 | 2020-10-08 |
| 1326654237 | Alissa Marie Buckanavage | Nurse Practitioner | 6223 Autumn View Dr, Harrisburg, PA 17112-1843 | 2020-09-17 |
| 1508471962 | Macey Schaffer | Nurse Practitioner | 2903 Broadway Ave, Pittsburgh, PA 15234-2801 | 2020-09-12 |
| 1710592472 | Novique Medical Aesthetics | Nurse Practitioner | 1715 S Easton Rd, Doylestown, PA 18901-5923 | 2020-09-10 |
| 1992318141 | Mary Jucel P Angeles | Nurse Practitioner | 100 E Lancaster Ave Ste 467, Wynnewood, PA 19096-3434 | 2020-08-27 |
| 1205448818 | Emily A Lockwood | Nurse Practitioner | 266 Lancaster Ave Ste 303, Malvern, PA 19355-3256 | 2020-08-17 |
| Find all providers with the same taxonomy | ||||
| City | FEASTERVILLE TREVOSE |
| Zip Code | 19053 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.