Provider Demographics
NPI:1386332914
Name:WHITE, TINA MARIE
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:WHITE
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 1:2850 PONTIAC LOOP
Mailing Address - Street 2:
Mailing Address - City:COTTONDALE
Mailing Address - State:FL
Mailing Address - Zip Code:32431-7320
Mailing Address - Country:US
Mailing Address - Phone:850-703-7909
Mailing Address - Fax:
Practice Address - Street 1:2850 PONTIAC LOOP
Practice Address - Street 2:
Practice Address - City:COTTONDALE
Practice Address - State:FL
Practice Address - Zip Code:32431-7320
Practice Address - Country:US
Practice Address - Phone:850-703-7909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide