Provider Demographics
NPI:1174879688
Name:TINDAL, REGINA M
Entity type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:M
Last Name:TINDAL
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 1:8111 MAHOGANY DR.
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE,
Mailing Address - State:NC
Mailing Address - Zip Code:28227
Mailing Address - Country:US
Mailing Address - Phone:704-563-1845
Mailing Address - Fax:
Practice Address - Street 1:8111 MAHOGANY DR.
Practice Address - Street 2:
Practice Address - City:CHARLOTTE,
Practice Address - State:NC
Practice Address - Zip Code:28227
Practice Address - Country:US
Practice Address - Phone:704-563-1845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC4553372500000X, 372600000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion