Provider Demographics
NPI:1215212246
Name:BUI-BURGOS, TINA T (CNP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:T
Last Name:BUI-BURGOS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:H
Other - Last Name:BUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 340
Mailing Address - Street 2:KEWA PUEBLO HEALTH CORPORATION
Mailing Address - City:SANTO DOMINGO PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87052-0340
Mailing Address - Country:US
Mailing Address - Phone:505-465-3060
Mailing Address - Fax:505-465-1191
Practice Address - Street 1:85 WEST HIGHWAY 22
Practice Address - Street 2:KEWA PUEBLO HEALTH CORPORATION
Practice Address - City:SANTO DOMINGO PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87052-0340
Practice Address - Country:US
Practice Address - Phone:505-465-3060
Practice Address - Fax:505-465-1191
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP01857363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily