Provider Demographics
NPI:1407195159
Name:MILLER, TINA RENA (MSN APRN NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:RENA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSN APRN NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8510 WILKINSVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-1537
Mailing Address - Country:US
Mailing Address - Phone:901-872-3114
Mailing Address - Fax:855-816-9602
Practice Address - Street 1:8510 WILKINSVILLE RD STE 104
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-1538
Practice Address - Country:US
Practice Address - Phone:901-872-3114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-31
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17269363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health