Provider Demographics
NPI:1376934174
Name:DONALDSON, TINA (RN, NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20800 SHERMAN WAY
Mailing Address - Street 2:EL PROYECTO DEL BARRIO
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2707
Mailing Address - Country:US
Mailing Address - Phone:818-715-9031
Mailing Address - Fax:
Practice Address - Street 1:20800 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2707
Practice Address - Country:US
Practice Address - Phone:818-715-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001375146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic