Provider Demographics
NPI:1831379627
Name:FAST, TINA MORELL (NP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MORELL
Last Name:FAST
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 TOWN PL STE 189163
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-1821
Mailing Address - Country:US
Mailing Address - Phone:469-457-4544
Mailing Address - Fax:
Practice Address - Street 1:5445 LA SIERRA DR STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-2352
Practice Address - Country:US
Practice Address - Phone:214-540-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA645189163W00000X, 163WC1500X, 163WS0200X
CA19642363LP0200X
TXAP144149363LP0808X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WS0200XNursing Service ProvidersRegistered NurseSchool
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty