Provider Demographics
NPI:1053640607
Name:GEBAROWSKI, TINA MARIE (NP)
Entity Type:Individual
Prefix:MRS
First Name:TINA MARIE
Middle Name:
Last Name:GEBAROWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-1252
Mailing Address - Country:US
Mailing Address - Phone:508-473-0435
Mailing Address - Fax:508-473-9755
Practice Address - Street 1:1 COUNTRYSIDE DR
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1252
Practice Address - Country:US
Practice Address - Phone:508-473-0435
Practice Address - Fax:508-473-9755
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA236502363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology