Provider Demographics
NPI:1588557821
Name:DIES, TINA RENEE (FNP-C)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:DIES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 ELLEN AVE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28716-3584
Mailing Address - Country:US
Mailing Address - Phone:704-779-4974
Mailing Address - Fax:
Practice Address - Street 1:127 SUNSET RIDGE RD
Practice Address - Street 2:
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8597
Practice Address - Country:US
Practice Address - Phone:828-452-8594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-03
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily