Provider Demographics
NPI:1487992194
Name:ADAMS, TINA RENEE (LPN, RN)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12927 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43103-9675
Mailing Address - Country:US
Mailing Address - Phone:740-600-2295
Mailing Address - Fax:
Practice Address - Street 1:12927 GIBSON RD
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:OH
Practice Address - Zip Code:43103-9675
Practice Address - Country:US
Practice Address - Phone:740-600-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH151891164W00000X
OH520239163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No164W00000XNursing Service ProvidersLicensed Practical Nurse