Provider Demographics
NPI:1356322341
Name:PAUL, TINA MARIE (APN-BC)
Entity Type:Individual
Prefix:MS
First Name:TINA
Middle Name:MARIE
Last Name:PAUL
Suffix:
Gender:F
Credentials:APN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4711 CENTERLINE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-1405
Mailing Address - Country:US
Mailing Address - Phone:865-647-3260
Mailing Address - Fax:865-647-3279
Practice Address - Street 1:4711 CENTERLINE DR STE 100
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-1405
Practice Address - Country:US
Practice Address - Phone:865-647-3260
Practice Address - Fax:865-647-3279
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN94868363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3346503Medicaid
103I502166Medicare PIN
TN3346504Medicare PIN
TN3373630Medicaid