Provider Demographics
NPI:1225090517
Name:CHRISTIAENS, TINA MICHELLE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:MICHELLE
Last Name:CHRISTIAENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:TINA
Other - Middle Name:MICHELLE
Other - Last Name:FROST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:8892 10TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8892 10TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-2936
Practice Address - Country:US
Practice Address - Phone:813-600-5920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103179363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant