Provider Demographics
NPI:1427094937
Name:DOCHNIAK, TINA M (DNP, ARNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:DOCHNIAK
Suffix:
Gender:F
Credentials:DNP, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12953 PALMS WEST DR STE 202
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4992
Mailing Address - Country:US
Mailing Address - Phone:561-331-2988
Mailing Address - Fax:561-231-5201
Practice Address - Street 1:13475 SOUTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9203
Practice Address - Country:US
Practice Address - Phone:561-231-5200
Practice Address - Fax:561-231-5201
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3257852363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP79393Medicare UPIN
FLU0028ZMedicare ID - Type Unspecified