Provider Demographics
NPI:1285962274
Name:PAYNE, TINA (RD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9068 N WILD EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85742-8756
Mailing Address - Country:US
Mailing Address - Phone:520-744-7260
Mailing Address - Fax:
Practice Address - Street 1:9068 N WILD EAGLE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85742-8756
Practice Address - Country:US
Practice Address - Phone:520-744-7260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-02
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered