Provider Demographics
NPI:1275183253
Name:THOMPSON, TINA TERREL (FNP-C, RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:TERREL
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50542
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80949-0542
Mailing Address - Country:US
Mailing Address - Phone:719-210-3207
Mailing Address - Fax:
Practice Address - Street 1:2130 ACADEMY CIR STE D
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1675
Practice Address - Country:US
Practice Address - Phone:719-425-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0994623-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14473158OtherCAQH