Provider Demographics
NPI:1063256113
Name:ALLEN, TINA M (DOULA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:ALLEN
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SW ASPEN GLN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-4030
Mailing Address - Country:US
Mailing Address - Phone:386-365-3673
Mailing Address - Fax:
Practice Address - Street 1:200 SW ASPEN GLN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-4030
Practice Address - Country:US
Practice Address - Phone:386-365-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL202406457374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula