Provider Demographics
NPI:1972151066
Name:ANDERSON, TINA
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 HIGHLAND HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-3219
Mailing Address - Country:US
Mailing Address - Phone:423-444-9642
Mailing Address - Fax:
Practice Address - Street 1:292 HIGHLAND HILLS DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-3219
Practice Address - Country:US
Practice Address - Phone:423-444-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-31
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant