Provider Demographics
NPI:1063950996
Name:BRAIMAH, TINA MOORE (RN, MSN, CNM)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MOORE
Last Name:BRAIMAH
Suffix:
Gender:F
Credentials:RN, MSN, CNM
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:NICOLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1412 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3353
Mailing Address - Country:US
Mailing Address - Phone:248-842-3960
Mailing Address - Fax:919-299-3050
Practice Address - Street 1:1412 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3353
Practice Address - Country:US
Practice Address - Phone:919-299-3050
Practice Address - Fax:919-999-2493
Is Sole Proprietor?:No
Enumeration Date:2017-02-12
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife