Provider Demographics
NPI:1538276241
Name:BROOKS, TINA MARIE (LVN LPN)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LVN LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 606
Mailing Address - Street 2:
Mailing Address - City:BOOKER
Mailing Address - State:TX
Mailing Address - Zip Code:79005-0606
Mailing Address - Country:US
Mailing Address - Phone:806-658-9289
Mailing Address - Fax:
Practice Address - Street 1:146 N. PIONEER
Practice Address - Street 2:
Practice Address - City:BOOKER
Practice Address - State:TX
Practice Address - Zip Code:79005-0550
Practice Address - Country:US
Practice Address - Phone:806-658-4531
Practice Address - Fax:806-658-9344
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKL0035986164W00000X
TX147398164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered164W00000XNursing Service ProvidersLicensed Practical Nurse
Not Answered164X00000XNursing Service ProvidersLicensed Vocational Nurse