Provider Demographics
NPI:1700682994
Name:MOFFETT, TINA MARIE (CNA , CMA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:CNA , CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 VINE ST APT J52
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2865
Mailing Address - Country:US
Mailing Address - Phone:319-576-5112
Mailing Address - Fax:
Practice Address - Street 1:1934 N 31ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-1301
Practice Address - Country:US
Practice Address - Phone:319-576-5112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE162579376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide