Provider Demographics
NPI:1396707444
Name:CELENZA, TINA M (PA-C)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:CELENZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 DALE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4217
Mailing Address - Country:US
Mailing Address - Phone:301-920-0996
Mailing Address - Fax:
Practice Address - Street 1:1701 14TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4308
Practice Address - Country:US
Practice Address - Phone:202-745-6171
Practice Address - Fax:202-745-0238
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030346363A00000X
MDC03002363A00000X
VA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant