Provider Demographics
NPI:1164970240
Name:CRAWFORD, TINA HUDSPETH
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:HUDSPETH
Last Name:CRAWFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:HUDSPETH
Other - Last Name:YOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:376 DIERLAM RD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SEADRIFT
Mailing Address - State:TX
Mailing Address - Zip Code:77983-3516
Mailing Address - Country:US
Mailing Address - Phone:361-484-8145
Mailing Address - Fax:
Practice Address - Street 1:376 DIERLAM RD
Practice Address - Street 2:
Practice Address - City:SEADRIFT
Practice Address - State:TX
Practice Address - Zip Code:77983-3516
Practice Address - Country:US
Practice Address - Phone:361-484-8145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-16
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor