Provider Demographics
NPI:1093577199
Name:PHIPPS, TINA RENEE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:RENEE
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6498 US HIGHWAY 221 S
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:NC
Mailing Address - Zip Code:28694-8029
Mailing Address - Country:US
Mailing Address - Phone:336-977-1988
Mailing Address - Fax:
Practice Address - Street 1:1006 S JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:NC
Practice Address - Zip Code:28694-9729
Practice Address - Country:US
Practice Address - Phone:226-219-0055
Practice Address - Fax:336-450-1854
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5019497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine