Provider Demographics
NPI:1154200798
Name:PORTER, TINA L (CNA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:L
Last Name:PORTER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16303 IMPERIAL VALLEY DR APT 905
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-3513
Mailing Address - Country:US
Mailing Address - Phone:330-990-9538
Mailing Address - Fax:
Practice Address - Street 1:16303 IMPERIAL VALLEY DR APT 905
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3513
Practice Address - Country:US
Practice Address - Phone:330-990-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-28
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA10092899251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health