Provider Demographics
NPI:1205231289
Name:BURLEIGH, TINA (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BURLEIGH
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 CLINES CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-9117
Mailing Address - Country:US
Mailing Address - Phone:740-835-8668
Mailing Address - Fax:740-835-8668
Practice Address - Street 1:4224 CLINES CHAPEL RD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-9117
Practice Address - Country:US
Practice Address - Phone:740-835-8668
Practice Address - Fax:740-835-8668
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-03
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.4081343747A0650X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider