Provider Demographics
NPI:1063726578
Name:MATTHEWS-HAYES, TINA MARIE (MSN, PMHNP-BC, FNP-C)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:MATTHEWS-HAYES
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:11740 SW 68TH PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-9058
Mailing Address - Country:US
Mailing Address - Phone:412-638-5490
Mailing Address - Fax:
Practice Address - Street 1:11740 SW 68TH PKWY STE 11740SW
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-9014
Practice Address - Country:US
Practice Address - Phone:425-477-4216
Practice Address - Fax:698-497-6984
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-27
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN601211163W00000X
PASP013074363L00000X
VA0024182838364SP0808X
OR10016847363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health