Basic Information
| Provider Information | |||||||||
| NPI: | 1124241831 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SMITH | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | CARITA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 230 | ||||||||
| Address2: | |||||||||
| City: | CORNELIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305310230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068942714 | ||||||||
| FaxNumber: | 7068942715 | ||||||||
| Practice Location | |||||||||
| Address1: | 184 PROFESSIONAL DR UNIT A | ||||||||
| Address2: | |||||||||
| City: | BALDWIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305114012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068942714 | ||||||||
| FaxNumber: | 7068942715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 05/13/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN063641 | GA | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | RN063641 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LW0102X | RN063641 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.