Provider Demographics
NPI:1073862686
Name:EASTERLING, TINA WALLACE (AUD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:WALLACE
Last Name:EASTERLING
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 SOUTH RAEFORD ROAD
Mailing Address - Street 2:VA FAYETTEVILLE HEALTH CARE CENTER / AUDIOLOGY
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7300 SOUTH RAEFORD ROAD
Practice Address - Street 2:VA FAYETTEVILLE HEALTH CARE CENTER / AUDIOLOGY
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-488-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4360231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist