Provider Demographics
NPI:1205023173
Name:BUTT, TINA MARIE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MARIE
Last Name:BUTT
Suffix:
Gender:F
Credentials:NP-C
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Mailing Address - Street 1:7590 AUBURN ROAD., SUITE 014
Mailing Address - Street 2:ATTN: MEDICAL STAFF
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9176
Mailing Address - Country:US
Mailing Address - Phone:440-354-1899
Mailing Address - Fax:440-354-1845
Practice Address - Street 1:9485 MENTOR AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8723
Practice Address - Country:US
Practice Address - Phone:440-255-5571
Practice Address - Fax:440-205-5744
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2021-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OHCOA.09534-NP163WG0000X
OHAPRN.CNP.09534363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice