NPIMap

Organization Active NPI

The Changing Tide Body Mind & Spirit PC Dba I Choose Life Inc.

Doing business as I Choose Life Inc.

  • Psychiatric/Mental Health Nurse Practitioner
  • Mathews, VA
National Provider Identifier
1962196683
Registry record updated Jun 20, 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 PC DBA I CHOOSE LIFE INC.
Doing business as
I Choose Life Inc.
Practice address
75 Main Street
Ste E
Mathews, VA 23109
Phone
(804) 725-3041
Fax
(804) 725-3510
NPI assigned
Jun 6, 2023
Last updated
Jun 20, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
THE CHANGING TIDE BODY, MIND & SPIRIT P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Authorized official

Name
Mrs. Debra Moore Zierow, PMHNP-BCNPI 1821592676
Title
Owner
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

75 Main Street
Ste E
Mathews, VA 23109

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
VVU978C639OtherVAMEDICARE
2019115759MedicaidVA

Other names 1

  • I Choose Life Inc. Doing business as

National Provider Directory

National Provider Directory
Part of
The Changing Tide Body Mind

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 5

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": "1686009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1962196683",
    "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": "804-725-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 MAIN STREET",
            "address_2": "STE E",
            "city": "MATHEWS",
            "state": "VA",
            "postal_code": "23109",
            "telephone_number": "804-725-3041",
            "fax_number": "804-725-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE CHANGING TIDE BODY MIND & SPIRIT PC DBA I CHOOSE LIFE INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE CHANGING TIDE BODY, MIND & SPIRIT P.C.",
        "enumeration_date": "2023-06-06",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "MOORE ZIEROW",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "804-725-3041",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "VVU978C639",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2019115759",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "I Choose Life Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "I Choose Life Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.