Provider Demographics
NPI:1700699469
Name:FARLEY, TINA CHRISTINE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:CHRISTINE
Last Name:FARLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 CEDARBERRY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-5948
Mailing Address - Country:US
Mailing Address - Phone:308-530-8983
Mailing Address - Fax:
Practice Address - Street 1:1514 BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-5733
Practice Address - Country:US
Practice Address - Phone:308-530-9623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider