Provider Demographics
NPI:1811298086
Name:NORMAN, TINA MICHELLE (LPN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MICHELLE
Last Name:NORMAN
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 1:1824 ROUTE 9G
Mailing Address - Street 2:LOT F8
Mailing Address - City:STAATSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12580-6180
Mailing Address - Country:US
Mailing Address - Phone:845-264-7170
Mailing Address - Fax:
Practice Address - Street 1:1824 ROUTE 9G
Practice Address - Street 2:LOT F8
Practice Address - City:STAATSBURG
Practice Address - State:NY
Practice Address - Zip Code:12580-6180
Practice Address - Country:US
Practice Address - Phone:845-264-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY279835-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY279835-1OtherLPN LICENSE