Provider Demographics
NPI:1902247059
Name:JAMES-GAMBLE, TINA RENEE (DHA II)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:JAMES-GAMBLE
Suffix:
Gender:F
Credentials:DHA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 RELAY ROAD
Mailing Address - Street 2:PO BOX 287
Mailing Address - City:ANGOON
Mailing Address - State:AK
Mailing Address - Zip Code:99820
Mailing Address - Country:US
Mailing Address - Phone:907-788-4655
Mailing Address - Fax:907-788-3180
Practice Address - Street 1:725 RELAY ROAD
Practice Address - Street 2:
Practice Address - City:ANGOON
Practice Address - State:AK
Practice Address - Zip Code:99820
Practice Address - Country:US
Practice Address - Phone:907-788-4655
Practice Address - Fax:907-788-3180
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK07-044-PDHA IIOtherCOMMUNITY HEALTH AIDE PROGRAM CERTIFICATION BOARD NUMBER