Provider Demographics
NPI:1083632616
Name:GEARY, TINA (MSN,ARNP-C)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GEARY
Suffix:
Gender:F
Credentials:MSN,ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 EDSEL LN NW
Mailing Address - Street 2:
Mailing Address - City:CORYDON
Mailing Address - State:IN
Mailing Address - Zip Code:47112-2136
Mailing Address - Country:US
Mailing Address - Phone:812-734-0303
Mailing Address - Fax:812-258-1094
Practice Address - Street 1:2230 EDSEL LN NW
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2136
Practice Address - Country:US
Practice Address - Phone:812-734-0303
Practice Address - Fax:812-258-1094
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000831363LP0808X
KY3003100363LF0000X
IN71002383A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN129780KMedicare ID - Type Unspecified