Provider Demographics
NPI:1538978291
Name:WORTH, TINA CHARISSE (RN, BSN, IBCLC)
Entity type:Individual
Prefix:MRS
First Name:TINA
Middle Name:CHARISSE
Last Name:WORTH
Suffix:
Gender:F
Credentials:RN, BSN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SWALLOWTAIL DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-7739
Mailing Address - Country:US
Mailing Address - Phone:863-667-6206
Mailing Address - Fax:
Practice Address - Street 1:700 SWALLOWTAIL DR
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-7739
Practice Address - Country:US
Practice Address - Phone:863-667-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9280550163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant