Provider Demographics
NPI:1699438390
Name:KLEIN, TINA MARIE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2891 TOWN TER
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-4352
Mailing Address - Country:US
Mailing Address - Phone:941-585-8659
Mailing Address - Fax:
Practice Address - Street 1:2891 TOWN TER
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-4352
Practice Address - Country:US
Practice Address - Phone:941-585-8659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016092363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily