Provider Demographics
NPI:1912657255
Name:SEVILLA, TINA MARIE (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:SEVILLA
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 PARKWOOD DR S
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8201
Mailing Address - Country:US
Mailing Address - Phone:561-644-6157
Mailing Address - Fax:
Practice Address - Street 1:234 PARKWOOD DR S
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-8201
Practice Address - Country:US
Practice Address - Phone:561-644-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11-18875363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner