Provider Demographics
NPI:1043287949
Name:SPINNER, TRICIA (PA)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:SPINNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 HIGHWAY 601
Mailing Address - Street 2:MIDLAND FAMILY MEDICINE
Mailing Address - City:MIDLAND
Mailing Address - State:NC
Mailing Address - Zip Code:28107-9536
Mailing Address - Country:US
Mailing Address - Phone:704-888-3702
Mailing Address - Fax:704-888-4192
Practice Address - Street 1:12925 HIGHWAY 601
Practice Address - Street 2:MIDLAND FAMILY MEDICINE
Practice Address - City:MIDLAND
Practice Address - State:NC
Practice Address - Zip Code:28107-9536
Practice Address - Country:US
Practice Address - Phone:704-888-3702
Practice Address - Fax:704-888-4192
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP48345Medicare UPIN