Provider Demographics
NPI:1992932396
Name:HARRIS, TINA MARIE (IDMT)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:939 MISSILE RD STE 1062
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AFB
Mailing Address - State:TX
Mailing Address - Zip Code:76311-2263
Mailing Address - Country:US
Mailing Address - Phone:940-676-3816
Mailing Address - Fax:
Practice Address - Street 1:5608 GREENTREE AVE
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76306-1145
Practice Address - Country:US
Practice Address - Phone:940-228-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians