Provider Demographics
NPI:1023354693
Name:TINU, ANITHA
Entity type:Individual
Prefix:
First Name:ANITHA
Middle Name:
Last Name:TINU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 CEDAR VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-4415
Mailing Address - Country:US
Mailing Address - Phone:972-506-3007
Mailing Address - Fax:972-506-3007
Practice Address - Street 1:3200 MATLOCK RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76015-2911
Practice Address - Country:US
Practice Address - Phone:214-492-3917
Practice Address - Fax:972-506-3007
Is Sole Proprietor?:No
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX683975363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health