Provider Demographics
NPI:1366023392
Name:SCHANTZ GROSS, TINA MARIE (RN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:SCHANTZ GROSS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:SCHANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4201 SKY FLOWER LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34772-8842
Mailing Address - Country:US
Mailing Address - Phone:321-684-9214
Mailing Address - Fax:
Practice Address - Street 1:516 E NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5748
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9226437163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse