Provider Demographics
NPI:1366688079
Name:KANE, TINA LOUISE (CRNP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:KANE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 NAAMANS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BOOTHWYN
Mailing Address - State:PA
Mailing Address - Zip Code:19061-2418
Mailing Address - Country:US
Mailing Address - Phone:267-207-5060
Mailing Address - Fax:
Practice Address - Street 1:3826 BAYSHORE RD
Practice Address - Street 2:
Practice Address - City:NORTH CAPE MAY
Practice Address - State:NJ
Practice Address - Zip Code:08204-3208
Practice Address - Country:US
Practice Address - Phone:609-886-3636
Practice Address - Fax:609-886-4880
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009794363LF0000X
NJ26NJ00245800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily