Provider Demographics
NPI:1407569379
Name:TOMAJIAN, ALINE ASSAKER (NP)
Entity Type:Individual
Prefix:
First Name:ALINE
Middle Name:ASSAKER
Last Name:TOMAJIAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ALINE
Other - Middle Name:
Other - Last Name:ASSAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10740 PLANTATION LN
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4058
Mailing Address - Country:US
Mailing Address - Phone:832-594-2921
Mailing Address - Fax:
Practice Address - Street 1:1340 BROAD AVE STE 450
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-2460
Practice Address - Country:US
Practice Address - Phone:228-867-5006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner