Provider Demographics
NPI:1326036302
Name:UMBERGER, TINA M (CRNA)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:UMBERGER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:1025 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2403
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:217-527-8956
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041265469367500000X
IL209003783367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041265469OtherIL LICENSE #
IL52332OtherAANA#
IL1285290Medicare ID - Type UnspecifiedMEDICARE UMWA GROUP #
IL794510Medicare ID - Type UnspecifiedMEDICARE GROUP#
IL069876OtherHEALTH ALLIANCE NUMBERS
IL52332OtherAANA#
IL709210Medicare ID - Type UnspecifiedMEDICARE PART B