Provider Demographics
NPI:1770998312
Name:RANGEL, TINA (RN IBCLC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:RANGEL
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE LN
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-7410
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 CIRCLE LN
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-7410
Practice Address - Country:US
Practice Address - Phone:817-999-8122
Practice Address - Fax:469-359-6979
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-23
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX796546163W00000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX796546OtherTEXAS BOARD OF NURSING
L-47019OtherINTERNATION BOARD CERTIFIED LACTATION CONSULTANT (IBCLC)