Provider Demographics
NPI:1336471382
Name:HARTFORD, TINA JEAN (RN)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:JEAN
Last Name:HARTFORD
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 1:46 COPELAND AVE
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1529
Mailing Address - Country:US
Mailing Address - Phone:607-283-9258
Mailing Address - Fax:
Practice Address - Street 1:224 S FULTON ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3306
Practice Address - Country:US
Practice Address - Phone:607-273-5335
Practice Address - Fax:607-273-1054
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY596204-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse