Provider Demographics
NPI:1548317316
Name:MAYLE, TINA ANN (MS, CPNP)
Entity type:Individual
Prefix:MS
First Name:TINA
Middle Name:ANN
Last Name:MAYLE
Suffix:
Gender:F
Credentials:MS, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-2666
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:209-370-9034
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11014108363LP0200X
NV843362363LP0200X
IL209023789363LP0200X
GAGAA-NP001130363LP0200X
CA95019517363LP0200X
COCAPN.0003258-C-NP363LP0200X
TXAP108995363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1548317316Medicaid
CO9000199675Medicaid
CA100247628Medicaid
FL113282800Medicaid
NV250015683Medicaid