Provider Demographics
NPI:1336782549
Name:GATES, TINA LOUISE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:GATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 DAPHIA CIR APT 84
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1185
Mailing Address - Country:US
Mailing Address - Phone:757-768-7827
Mailing Address - Fax:757-782-2667
Practice Address - Street 1:900 DAPHIA CIR APT 84
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-1185
Practice Address - Country:US
Practice Address - Phone:757-768-7827
Practice Address - Fax:757-782-2667
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle