Provider Demographics
NPI:1376791673
Name:GOODPASTURE, TINA (FNP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GOODPASTURE
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:1103 N ELM ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6309
Mailing Address - Country:US
Mailing Address - Phone:336-271-3331
Mailing Address - Fax:336-271-3724
Practice Address - Street 1:1103 N ELM ST
Practice Address - Street 2:SUITE 300
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6309
Practice Address - Country:US
Practice Address - Phone:336-271-3331
Practice Address - Fax:336-271-3724
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5004054363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901685Medicaid
NC230159OtherMEDICARE