Provider Demographics
NPI:1992098347
Name:NESTLE, TINA MARIE (ATC)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:NESTLE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 S 4 3/4 MILE RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8311
Mailing Address - Country:US
Mailing Address - Phone:989-631-5553
Mailing Address - Fax:
Practice Address - Street 1:1629 S 4 3/4 MILE RD
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-8311
Practice Address - Country:US
Practice Address - Phone:989-631-5553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010004942255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer