Provider Demographics
NPI:1124081500
Name:BAULER, TINA L (RNFA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:BAULER
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52320
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85208-0116
Mailing Address - Country:US
Mailing Address - Phone:480-545-2610
Mailing Address - Fax:480-545-2673
Practice Address - Street 1:8724 E ROSE ST
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85208-1528
Practice Address - Country:US
Practice Address - Phone:480-545-2610
Practice Address - Fax:480-545-2373
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2020-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN079847163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ844771Medicaid
AZAZ0280450OtherBCBS
AZ1Z5768OtherHEALTHNET OF AZ