Provider Demographics
NPI:1124320312
Name:BOYD-SENG, TINA (FNP-BC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BOYD-SENG
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:BOYD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:97 JADEWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305
Mailing Address - Country:US
Mailing Address - Phone:731-217-0449
Mailing Address - Fax:
Practice Address - Street 1:1950 US HIGHWAY 51 BYP N
Practice Address - Street 2:
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1896
Practice Address - Country:US
Practice Address - Phone:731-217-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily