Provider Demographics
NPI:1558380246
Name:SCHAFFER, TINA M (ANP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61602-5003
Mailing Address - Country:US
Mailing Address - Phone:309-671-7772
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61602-5003
Practice Address - Country:US
Practice Address - Phone:309-671-7772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005632363LA2100X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
10215111OtherBLUE CROSS BLUE SHIELD
IL374440Medicare ID - Type UnspecifiedMEDICARE GROUP SCM
10215111OtherBLUE CROSS BLUE SHIELD
IL748943Medicare ID - Type UnspecifiedMEDICARE GROUP EP
K23074Medicare ID - Type Unspecified
IL712180Medicare ID - Type UnspecifiedMEDICARE GROUP TCH
IL748940Medicare ID - Type UnspecifiedMEDICARE GROUP HPT
ILK30956Medicare ID - Type UnspecifiedMEDICARE PIN INT
ILK30961Medicare ID - Type UnspecifiedMEDICARE PIN LEX
IL206706Medicare ID - Type UnspecifiedMEDICARE GROUP LFM
IL748942Medicare ID - Type UnspecifiedMEDICARE GROUP LEX
ILK30959Medicare ID - Type UnspecifiedMEDICARE PIN LFM
ILK30957Medicare ID - Type UnspecifiedMEDICARE PIN FMA
ILK30958Medicare ID - Type UnspecifiedMEDICARE PIN SCM
ILK30965Medicare ID - Type UnspecifiedMEDICARE PIN EP
IL200871Medicare ID - Type UnspecifiedMEDICARE GROUP INT
ILK30960Medicare ID - Type UnspecifiedMEDICARE PIN HPT