Provider Demographics
NPI:1073768974
Name:BOGGS, TINA (CNA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BOGGS
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 LANNING AVE
Mailing Address - Street 2:
Mailing Address - City:PENNS GROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08069-1200
Mailing Address - Country:US
Mailing Address - Phone:800-950-6066
Mailing Address - Fax:
Practice Address - Street 1:81 LANNING AVE
Practice Address - Street 2:
Practice Address - City:PENNS GROVE
Practice Address - State:NJ
Practice Address - Zip Code:08069-1200
Practice Address - Country:US
Practice Address - Phone:800-950-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNA0006987302376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide