Provider Demographics
NPI:1497309363
Name:MUAGBA, ELOHOR TESSY (NP)
Entity type:Individual
Prefix:
First Name:ELOHOR
Middle Name:TESSY
Last Name:MUAGBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3201
Mailing Address - Country:US
Mailing Address - Phone:240-646-6352
Mailing Address - Fax:
Practice Address - Street 1:3412 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3201
Practice Address - Country:US
Practice Address - Phone:240-646-6352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY44506363LP0808X
VA0024183970363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health