Provider Demographics
NPI:1538525639
Name:GEHRKE, TINA MARIE (FNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:GEHRKE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8540 SCARBOROUGH DR
Mailing Address - Street 2:STE 370
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7519
Mailing Address - Country:US
Mailing Address - Phone:719-358-8270
Mailing Address - Fax:719-358-8299
Practice Address - Street 1:715 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3289
Practice Address - Country:US
Practice Address - Phone:719-471-9891
Practice Address - Fax:719-471-4493
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COAPN.0991756-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily