NPIMap

Organization Active NPI

The Changing Tide Body, Mind & Spirit P.C.

  • Psychiatric/Mental Health Nurse Practitioner
  • Mathews, VA
National Provider Identifier
1144874447
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
THE CHANGING TIDE BODY, MIND & SPIRIT P.C.
Practice address
10978 Buckley Hall Road
Mathews, VA 23109-2310
Phone
(804) 725-3041
Fax
(804) 725-3510
NPI assigned
Jul 25, 2019
Last updated
Jun 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debra Giuliana Moore-Zierow, MSN, FNP-BC, PMHNP-BNPI 1821592676
Title
Ceo
Phone
(804) 725-3041

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary

Addresses

Primary practice location

10978 Buckley Hall Road
Mathews, VA 23109-2310

Mailing address

PO Box 327
Mathews, VA 23109-0327
Phone (804) 725-3041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200218000288 VA Part B Supplier - Clinic/Group Practice 9133556996 Receives reassigned benefits from 3 practitioners
Practice locations: Mathews, VA

National Provider Directory

National Provider Directory

Locations

75 Main St
#A
Mathews, VA 23109
Phone (804) 725-3041

75 Main St
Ste A
Mathews, VA 23109
Phone (804) 725-3041

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686528000000",
    "number": "1144874447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 327",
            "city": "MATHEWS",
            "state": "VA",
            "postal_code": "231090327",
            "telephone_number": "804-725-3041",
            "fax_number": "804-725-3041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10978 BUCKLEY HALL ROAD",
            "city": "MATHEWS",
            "state": "VA",
            "postal_code": "231092310",
            "telephone_number": "804-725-3041",
            "fax_number": "804-725-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHANGING TIDE BODY, MIND & SPIRIT P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-25",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "MOORE-ZIEROW",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "GIULIANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "804-725-3041",
        "authorized_official_credential": "MSN, FNP-BC, PMHNP-B"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mathews, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.