Provider Demographics
NPI:1093124984
Name:NING, TINA FONG (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:FONG
Last Name:NING
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:CHEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79604-1198
Mailing Address - Country:US
Mailing Address - Phone:325-670-4372
Mailing Address - Fax:325-670-4040
Practice Address - Street 1:1201 N 18TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79601-2932
Practice Address - Country:US
Practice Address - Phone:325-793-3100
Practice Address - Fax:325-793-3195
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9108008363A00000X
TXPA10673363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX360742601Medicaid
FL012955200Medicaid
TX518377YM7PMedicare PIN
FLHX427ZMedicare PIN