Provider Demographics
NPI:1588308860
Name:WALKER, TINA D (ARNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:D
Last Name:WALKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13549 BISCAYNE GROVE LN
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32735-9647
Mailing Address - Country:US
Mailing Address - Phone:941-270-5012
Mailing Address - Fax:
Practice Address - Street 1:2101 PREVATT ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6131
Practice Address - Country:US
Practice Address - Phone:352-589-4774
Practice Address - Fax:352-589-5092
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11013266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily