Provider Demographics
NPI:1154331346
Name:RAY, TINEY ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:TINEY
Middle Name:ELIZABETH
Last Name:RAY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MERCER ST
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776-6106
Mailing Address - Country:US
Mailing Address - Phone:845-216-9886
Mailing Address - Fax:631-828-6869
Practice Address - Street 1:400 CONGRESS ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3553
Practice Address - Country:US
Practice Address - Phone:888-987-3991
Practice Address - Fax:888-502-6598
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2025-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN229184363LP0808X, 363LF0000X
MN7456363LP0808X, 363LF0000X
MECNP161188363LF0000X, 363LP0808X
VT101.0125069363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily