Provider Demographics
NPI:1932389194
Name:WILLIAMSON, TINA JOANNE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:JOANNE
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:COPPLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1188
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:832 ELM ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-812-5820
Practice Address - Fax:541-812-5821
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200241926RN163WM0705X
OR202111413NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202111413NP-PPOtherNURSE PRACTITIONER LICENSURE - OSBN