Provider Demographics
NPI:1104005131
Name:HATFIELD, TINA MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1532 MAPLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DE KALB JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:13630-4179
Mailing Address - Country:US
Mailing Address - Phone:315-347-3158
Mailing Address - Fax:
Practice Address - Street 1:1532 MAPLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:DE KALB JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:13630-4179
Practice Address - Country:US
Practice Address - Phone:315-347-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY290050164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse