Provider Demographics
NPI:1881142784
Name:EVANS, TINA MARIE (NP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:EVANS
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:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:CROSS PLAINS
Mailing Address - State:TN
Mailing Address - Zip Code:37049-0192
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5511 VIRGINIA WAY STE 300
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7611
Practice Address - Country:US
Practice Address - Phone:615-994-1000
Practice Address - Fax:615-994-0100
Is Sole Proprietor?:No
Enumeration Date:2016-09-20
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN82404164W00000X
TN220356163W00000X
TN31288363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse