Provider Demographics
NPI:1902916851
Name:CLOIN, TINA ANN (PA-C)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ANN
Last Name:CLOIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:ANN
Other - Last Name:DIEKEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:310 N 7 HILLS RD STE 220
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-4111
Mailing Address - Country:US
Mailing Address - Phone:618-624-6181
Mailing Address - Fax:
Practice Address - Street 1:310 N 7 HILLS RD STE 220
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-4111
Practice Address - Country:US
Practice Address - Phone:618-624-6181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085001478363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL3374051Medicare PIN