Provider Demographics
NPI:1144346487
Name:JASPAN, TINA B
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:B
Last Name:JASPAN
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 1:1936 N HIGHLAND AVE
Mailing Address - Street 2:SUITE B.
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-4537
Mailing Address - Country:US
Mailing Address - Phone:800-400-4210
Mailing Address - Fax:800-771-9243
Practice Address - Street 1:1936 N HIGHLAND AVE
Practice Address - Street 2:SUITE B.
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-4537
Practice Address - Country:US
Practice Address - Phone:800-400-4210
Practice Address - Fax:800-771-9243
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000991332B00000X
TN0000003066332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4582109Medicaid
TN0877690001Medicare NSC