Provider Demographics
NPI:1043724347
Name:HOLLIS, TINA M (FNP)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:M
Last Name:HOLLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 SUMMER OAKS DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3854
Mailing Address - Country:US
Mailing Address - Phone:901-730-7360
Mailing Address - Fax:
Practice Address - Street 1:2840 SUMMER OAKS DR STE 101
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3854
Practice Address - Country:US
Practice Address - Phone:901-730-7360
Practice Address - Fax:901-881-5972
Is Sole Proprietor?:No
Enumeration Date:2017-11-22
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23562363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ033272Medicaid