Provider Demographics
NPI:1730860529
Name:NORRIS, TINA (LPN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:NORRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 HILLVIEW ESTATES RD
Mailing Address - Street 2:
Mailing Address - City:TOMPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42167-7733
Mailing Address - Country:US
Mailing Address - Phone:270-459-2456
Mailing Address - Fax:
Practice Address - Street 1:593 HILLVIEW ESTATES RD
Practice Address - Street 2:
Practice Address - City:TOMPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42167-7733
Practice Address - Country:US
Practice Address - Phone:270-459-2456
Practice Address - Fax:270-459-2456
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2045956164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse